Latina Community College Leadership in California: Pathways to Executive Management

ERIC Educational Resources Information Center

Delgadillo, Monica D.

2017-01-01

Purpose: The purpose of this qualitative study was to examine the learned experiences, challenges, and leadership pathways of Latinas currently in California community college management positions. Latinas have been underrepresented in community college leadership positions. Currently, women constitute a majority of those attending college, and…

Preparing the Next Generations of Technology Project Managers to Lead through Knowledge Sharing: A Case Study at a Large Transportation Company

ERIC Educational Resources Information Center

Kargbo, Michelle

2013-01-01

The purpose of this research was to identify knowledge transfer gaps and current practices, prepare current project managers to accept the challenges associated with leadership opportunities that are coming available due to retirements through cross training efforts and succession planning, and to identify the proper management of knowledge…

Managed Moves: School and Local Authority Staff Perceptions of Processes, Success and Challenges

ERIC Educational Resources Information Center

Bagley, Christopher; Hallam, Susan

2015-01-01

The current research aimed to increase understanding of the processes of managed moves for children at risk of exclusion from school, particularly exploring what contributed to success and the nature of the challenges experienced. The study was conducted in one English local authority where 11 school staff and 5 local authority staff were…

An expanded conceptual framework for solution-focused management of chemical pollution in European waters.

PubMed

Munthe, John; Brorström-Lundén, Eva; Rahmberg, Magnus; Posthuma, Leo; Altenburger, Rolf; Brack, Werner; Bunke, Dirk; Engelen, Guy; Gawlik, Bernd Manfred; van Gils, Jos; Herráez, David López; Rydberg, Tomas; Slobodnik, Jaroslav; van Wezel, Annemarie

2017-01-01

This paper describes a conceptual framework for solutions-focused management of chemical contaminants built on novel and systematic approaches for identifying, quantifying and reducing risks of these substances. The conceptual framework was developed in interaction with stakeholders representing relevant authorities and organisations responsible for managing environmental quality of water bodies. Stakeholder needs were compiled via a survey and dialogue. The content of the conceptual framework was thereafter developed with inputs from relevant scientific disciplines. The conceptual framework consists of four access points: Chemicals, Environment, Abatement and Society, representing different aspects and approaches to engaging in the issue of chemical contamination of surface waters. It widens the scope for assessment and management of chemicals in comparison to a traditional (mostly) perchemical risk assessment approaches by including abatement- and societal approaches as optional solutions. The solution-focused approach implies an identification of abatement- and policy options upfront in the risk assessment process. The conceptual framework was designed for use in current and future chemical pollution assessments for the aquatic environment, including the specific challenges encountered in prioritising individual chemicals and mixtures, and is applicable for the development of approaches for safe chemical management in a broader sense. The four access points of the conceptual framework are interlinked by four key topics representing the main scientific challenges that need to be addressed, i.e.: identifying and prioritising hazardous chemicals at different scales; selecting relevant and efficient abatement options; providing regulatory support for chemicals management; predicting and prioritising future chemical risks. The conceptual framework aligns current challenges in the safe production and use of chemicals. The current state of knowledge and implementation of these challenges is described. The use of the conceptual framework, and addressing the challenges, is intended to support: (1) forwarding sustainable use of chemicals, (2) identification of pollutants of priority concern for cost-effective management, (3) the selection of optimal abatement options and (4) the development and use of optimised legal and policy instruments.

The laboratory workforce shortage: a managerial perspective.

PubMed

Cortelyou-Ward, Kendall; Ramirez, Bernardo; Rotarius, Timothy

2011-01-01

Most clinical laboratories in the nation report severe difficulties in recruitment and retention of most types of personnel. Other important factors impacting this problem include work complexities, increased automation, and a graying workforce. As a further challenge, institutional needs for clinical laboratory personnel are expected to grow significantly in the next decade. This article examines the current situation of the clinical laboratory workforce. It analyzes the different types of personnel; the managerial, supervision, and line positions that are key for different types of laboratories; the job outlook and recent projections for different types of staff; and the current issues, trends, and challenges of the laboratory workforce. Laboratory managers need to take action with strategies suggested for overcoming these challenges. Most importantly, they need to become transformational leaders by developing effective staffing models, fostering healthy and productive work environments, and creating value with a strategic management culture and implementation of knowledge management.

Challenges to Successful Total Quality Management Implementation in Public Secondary Schools: A Case Study of Kohat District, Pakistan

ERIC Educational Resources Information Center

Suleman, Qaiser; Gul, Rizwana

2015-01-01

The current study explores the challenges faced by public secondary schools in successful implementation of total quality management (TQM) in Kohat District. A sample of 25 heads and 75 secondary school teachers selected from 25 public secondary schools through simple random sampling technique was used. Descriptive research designed was used and a…

An introduction to global carbon cycle management

USGS Publications Warehouse

Sundquist, Eric T.; Ackerman, Katherine V.; Parker, Lauren; Huntzinger, Deborah N.

2009-01-01

Past and current human activities have fundamentally altered the global carbon cycle. Potential future efforts to control atmospheric CO2 will also involve significant changes in the global carbon cycle. Carbon cycle scientists and engineers now face not only the difficulties of recording and understanding past and present changes but also the challenge of providing information and tools for new management strategies that are responsive to societal needs. The challenge is nothing less than managing the global carbon cycle.

Challenges and opportunities of health care supply chain management in the United States.

PubMed

Elmuti, Dean; Khoury, Grace; Omran, Omar; Abou-Zaid, Ahmed S

2013-01-01

This article explores current supply chain management challenges and initiatives and identifies problems that affect supply chain management success in the U.S. health-care industry. In addition, it investigates the impact of health care supply chain management (SCM) initiatives on the overall organizational effectiveness. The attitudinal results, as well as the performance results presented in this study support the claim of health care proponents that the SCM allows organizations to reduce cost, improve quality, and reduce cycle time, and leads to high performance.

A paradigm shift on beta-thalassaemia treatment: How will we manage this old disease with new therapies?

PubMed

Cappellini, Maria Domenica; Porter, John B; Viprakasit, Vip; Taher, Ali T

2018-07-01

Beta-thalassaemia causes defective haemoglobin synthesis leading to ineffective erythropoiesis, chronic haemolytic anaemia, and subsequent clinical complications. Blood transfusion and iron chelation allow long-term disease control, and haematopoietic stem cell transplantation offers a potential cure for some patients. Nonetheless, there are still many challenges in the management of beta-thalassaemia. The main treatment option for most patients is supportive care; furthermore, the long-term efficacy and safety of current therapeutic strategies are limited and adherence is suboptimal. An increasing understanding of the underlying molecular and cellular disease mechanisms plus an awareness of limitations of current management strategies are driving research into novel therapeutic options. Here we provide an overview of the current pathophysiology, clinical manifestations, and global burden of beta-thalassaemia. We reflect on what has been achieved to date, describe the challenges associated with currently available therapy, and discuss how these issues might be addressed by novel therapeutic approaches in development. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

A meta-analysis of human-system interfaces in unmanned aerial vehicle (UAV) swarm management.

PubMed

Hocraffer, Amy; Nam, Chang S

2017-01-01

A meta-analysis was conducted to systematically evaluate the current state of research on human-system interfaces for users controlling semi-autonomous swarms composed of groups of drones or unmanned aerial vehicles (UAVs). UAV swarms pose several human factors challenges, such as high cognitive demands, non-intuitive behavior, and serious consequences for errors. This article presents findings from a meta-analysis of 27 UAV swarm management papers focused on the human-system interface and human factors concerns, providing an overview of the advantages, challenges, and limitations of current UAV management interfaces, as well as information on how these interfaces are currently evaluated. In general allowing user and mission-specific customization to user interfaces and raising the swarm's level of autonomy to reduce operator cognitive workload are beneficial and improve situation awareness (SA). It is clear more research is needed in this rapidly evolving field. Copyright © 2016 Elsevier Ltd. All rights reserved.

Adaptive Management: From More Talk to Real Action

NASA Astrophysics Data System (ADS)

Williams, Byron K.; Brown, Eleanor D.

2014-02-01

The challenges currently facing resource managers are large-scale and complex, and demand new approaches to balance development and conservation goals. One approach that shows considerable promise for addressing these challenges is adaptive management, which by now is broadly seen as a natural, intuitive, and potentially effective way to address decision-making in the face of uncertainties. Yet the concept of adaptive management continues to evolve, and its record of success remains limited. In this article, we present an operational framework for adaptive decision-making, and describe the challenges and opportunities in applying it to real-world problems. We discuss the key elements required for adaptive decision-making, and their integration into an iterative process that highlights and distinguishes technical and social learning. We illustrate the elements and processes of the framework with some successful on-the-ground examples of natural resource management. Finally, we address some of the difficulties in applying learning-based management, and finish with a discussion of future directions and strategic challenges.

Current Challenges in the Management of Prolactinomas.

PubMed

Maiter, Dominique

2015-04-01

Although the diagnosis of prolactinoma is often straightforward and the treatment strategy has been well defined in recent guidelines, several challenging issues persist in their management. The differential diagnosis of a large pituitary tumour with moderately elevated prolactin (PRL) concentrations is sometimes difficult, and prolonged treatment with a dopamine agonist may be inappropriate when the diagnosis of a prolactinoma is not sufficiently well substantiated. Also, timely withdrawal of dopamine agonist treatment and the remaining indications of transsphenoidal surgery are still matters of debate. Last but not least, the management of resistant or aggressive prolactinomas remains a challenge for the clinician, especially when they occur in young patients.

Current Challenges in the Management of Prolactinomas

PubMed Central

2015-01-01

Summary Although the diagnosis of prolactinoma is often straightforward and the treatment strategy has been well defined in recent guidelines, several challenging issues persist in their management. The differential diagnosis of a large pituitary tumour with moderately elevated prolactin (PRL) concentrations is sometimes difficult, and prolonged treatment with a dopamine agonist may be inappropriate when the diagnosis of a prolactinoma is not sufficiently well substantiated. Also, timely withdrawal of dopamine agonist treatment and the remaining indications of transsphenoidal surgery are still matters of debate. Last but not least, the management of resistant or aggressive prolactinomas remains a challenge for the clinician, especially when they occur in young patients. PMID:29632566

Hepatitis B Virus Infection in Tanzania: Current Status and Challenges

PubMed Central

Bakshi, Fatma A.; Jaka, Hyasinta

2018-01-01

Hepatitis B is one of the most common infectious diseases in the world with high prevalence in most of sub-Saharan Africa countries. The complexity in its diagnosis and treatment poses a significant management challenge in the resource-limited settings including Tanzania, where most of the tests and drugs are either unavailable or unaffordable. This mini review aims at demonstrating the current status of the disease in the country and discussing the concomitant challenges in diagnosis, treatment, and prevention. PMID:29666656

Water management: Current and future challenges and research directions

NASA Astrophysics Data System (ADS)

Cosgrove, William J.; Loucks, Daniel P.

2015-06-01

Water distinguishes our planet compared to all the others we know about. While the global supply of available freshwater is more than adequate to meet all current and foreseeable water demands, its spatial and temporal distributions are not. There are many regions where our freshwater resources are inadequate to meet domestic, economic development and environmental needs. In such regions, the lack of adequate clean water to meet human drinking water and sanitation needs is indeed a constraint on human health and productivity and hence on economic development as well as on the maintenance of a clean environment and healthy ecosystems. All of us involved in research must find ways to remove these constraints. We face multiple challenges in doing that, especially given a changing and uncertain future climate, and a rapidly growing population that is driving increased social and economic development, globalization, and urbanization. How best to meet these challenges requires research in all aspects of water management. Since 1965, the journal Water Resources Research has played an important role in reporting and disseminating current research related to managing the quantity and quality and cost of this resource. This paper identifies the issues facing water managers today and future research needed to better inform those who strive to create a more sustainable and desirable future.

Water Utility Management Strategies in Turkey: The current situation and the challenges

NASA Astrophysics Data System (ADS)

Alp, E.; Aksoy, M. N.; Koçer, B.

2013-12-01

As the effects of climate change becomes more prominent, current challenges related to water and wastewater management is becoming more serious. Providing water that satisfies environmental and safety standards in terms of quantity and quality is needed to maintain human life without compromising the need of future generations. Besides providing safe and affordable water, necessary treatment should be achieved according to several important factors such as receiving body standards, discharge standards, water reuse options. Therefore, management of water becomes more crucial than ever that states have to provide accessibility of safe water with affordable cost to its citizens with the means of effective utility management, including water treatment facilities, wastewater treatment facilities, water supply facilities and water distribution systems. Water utilities encounter with several challenges related to cost, infrastructure, population, legislation, workforce and resource. This study aims to determine the current situation and the necessary strategies to improve utility management in Turkish municipalities in a sustainable manner. US Environment Protection Agency (EPA) has formed a tool on effective utility management that assists utilities to provide a solution for both current and future challenges. In this study, we used EPA's guidelines and developed a survey consists of 60 questions under 10 sub-topics (Product Quality, Employee & Leadership Development, Stakeholder Understanding & Support, Operational Optimization, Infrastructure Stability, Financial Viability, Community Sustainability, Customer Satisfaction, Operational Resiliency, and Water Resource Adequacy). This survey was sent to the managers of 25 metropolitan municipalities in Turkey to assess the current condition of municipalities. After the evaluation of the survey results for each topic, including the importance given by managers, facilities were rated according to their level of achievement. The scores were given for Rate Achievement from 1 to 5 and Rank Importance from 1 to 10 to the survey outcomes for each topic. Then, rating and ranking matrix was constructed according to score ranges. Results show that Product Quality, Stakeholder Understanding & Support, Infrastructure Stability and Customer Satisfaction are the major topics that needs to be improved according to the utility managers in Turkey. According to the outcomes of the study, water losses and unbilled unmetered consumption of water appeared to be the most important issues with the utility management. The utility managers also think there is still room for improvement to satisfy the needs of the users. Even though the rehabilitation of the infrastructure is a costly investment, it can be compensated with the help of the increased revenues as a result of improvement in water loss and unbilled water use. Suggestions given as a result of this study aim to aid decision makers and local authorities to overcome the significant problems faced during management and to achieve a sustainable utility management.

Topical, Biological and Clinical Challenges in the Management of Patients with Acne Vulgaris

PubMed Central

Al-Hammadi, Anwar; Al-Ismaily, Abla; Al-Ali, Sameer; Ramadurai, Rajesh; Jain, Rishi; McKinley-Grant, Lynn; Mughal, Tariq I.

2016-01-01

Acne vulgaris is one of the most common chronic inflammatory skin disorders among adolescents and young adults. It is associated with substantial morbidity and, rarely, with mortality. The exact worldwide incidence and prevalence are currently unknown. Current challenges involve improving understanding of the underlying pathophysiology of acne vulgaris and developing a practical treatment consensus. Expert panel discussions were held in 2013 and 2014 among a group of scientists and clinicians from the Omani and United Arab Emirate Dermatology Societies to ascertain the current optimal management of acne vulgaris, identify clinically relevant end-points and construct suitable methodology for future clinical trial designs. This article reviews the discussions of these sessions and recent literature on this topic. PMID:27226905

Current Ketamine Practice: Results of the 2016 American Society of Pain Management Nursing Survey on Ketamine.

PubMed

Klaess, Cynthia C; Jungquist, Carla R

2018-06-01

Ketamine is increasingly utilized for a variety of pain management challenges. Audience comments from a ketamine presentation at the 2015 American Society of Pain Management Nursing (ASPMN) Conference reflected wide variation in ketamine practices as well as barriers to use. The goal was to gain a greater understanding of ASPMN member practice patterns and barriers related to ketamine as adjunctive therapy for pain management. A questionnaire survey design was used. Respondents represented 35 states and 2 countries. The participants were 146 respondents from ASPMN membership (1,485 members). The survey was distributed by ASPMN on SurveyMonkey. Practice setting and ketamine administration practices were assessed with areas for comments. Results were reviewed using frequencies to describe responses and formatted into tables. Comments were individually reviewed and grouped into common themes. Administration of ketamine as an analgesic was reported by 63% of respondents. Continuous intravenous ketamine infusions were the most common route of administration (65%); however, wide variability in dosing and length of therapy was reported. A wide variety of practices and challenges related to ketamine utilization were noted. Numerous studies have indicated the analgesic benefits of ketamine in pain management. The lack of practice standardization has created challenges to its consistent use and outcome measurement. Additionally, the off-label use of ketamine for pain management creates its own unique challenges. However, given the current national climate with intense focus on pain management, interdisciplinary practitioners have an ideal opportunity to evaluate ketamine's use in a comprehensive approach to pain management. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Designing patient-centric applications for chronic disease management.

PubMed

Tsalatsanis, Athanasios; Gil-Herrera, Eleazar; Yalcin, Ali; Djulbegovic, Benjamin; Barnes, Laura

2011-01-01

Chronic diseases such as diabetes and heart disease are the leading causes of disability and death in the developed world. Technological interventions such as mobile applications have the ability to facilitate and motivate patients in chronic disease management, but these types of interventions present considerable design challenges. The primary objective of this paper is to present the challenges arising from the design and implementation of software applications aiming to assist patients in chronic disease management. We also outline preliminary results regarding a self-management application currently under development targeting young adults suffering from type 1 diabetes.

Thinking on your feet: understanding the immediate responses of staff to adults who challenge intellectual disability services.

PubMed

Ravoux, Peggy; Baker, Peter; Brown, Hilary

2012-05-01

A gap prevails between the conceptualization of good practice in challenging behaviour management and its implementation in intellectual disability services. This study aimed to investigate staff members' perspectives of managing clients with challenging behaviours in residential services. Semi-structured interviews were conducted with eleven staff in two services. Additionally, service documents on challenging behaviour management were examined in these services. A qualitative methodology was used to investigate staff members' immediate responses to clients' difficult behaviours and their decision-making processes. The immediate responses of staff were conceptualized as the result of complex appraisals shaped by their service context involving the core processes of making the right choice and prioritizing the best interests of all involved. Staff members' responses were understood as a dynamic and retroactive process, where their past and current challenging behaviour management experiences in the service influenced their responses to clients in the future. © 2011 Blackwell Publishing Ltd.

A multi-domain trust management model for supporting RFID applications of IoT

PubMed Central

Li, Feng

2017-01-01

The use of RFID technology in complex and distributed environments often leads to a multi-domain RFID system, in which trust establishment among entities from heterogeneous domains without past interaction or prior agreed policy, is a challenge. The current trust management mechanisms in the literature do not meet the specific requirements in multi-domain RFID systems. Therefore, this paper analyzes the special challenges on trust management in multi-domain RFID systems, and identifies the implications and the requirements of the challenges on the solutions to the trust management of multi-domain RFID systems. A multi-domain trust management model is proposed, which provides a hierarchical trust management framework include a diversity of trust evaluation and establishment approaches. The simulation results and analysis show that the proposed method has excellent ability to deal with the trust relationships, better security, and higher accuracy rate. PMID:28708855

A multi-domain trust management model for supporting RFID applications of IoT.

PubMed

Wu, Xu; Li, Feng

2017-01-01

The use of RFID technology in complex and distributed environments often leads to a multi-domain RFID system, in which trust establishment among entities from heterogeneous domains without past interaction or prior agreed policy, is a challenge. The current trust management mechanisms in the literature do not meet the specific requirements in multi-domain RFID systems. Therefore, this paper analyzes the special challenges on trust management in multi-domain RFID systems, and identifies the implications and the requirements of the challenges on the solutions to the trust management of multi-domain RFID systems. A multi-domain trust management model is proposed, which provides a hierarchical trust management framework include a diversity of trust evaluation and establishment approaches. The simulation results and analysis show that the proposed method has excellent ability to deal with the trust relationships, better security, and higher accuracy rate.

Current challenges in optimizing systemic therapy for patients with pancreatic cancer: expert perspectives from the Australasian Gastrointestinal Trials Group (AGITG) with invited international faculty.

PubMed

Segelov, Eva; Lordick, Florian; Goldstein, David; Chantrill, Lorraine A; Croagh, Daniel; Lawrence, Ben; Arnold, Dirk; Chau, Ian; Obermannova, Radka; Price, Timothy Jay

2017-10-01

Despite recent progress, the outlook for most patients with pancreatic cancer remains poor. There is variation in how patients are managed globally due to differing interpretations of the evidence, partly because studies in this disease are challenging to undertake. This article collates the evidence upon which current best practice is based and offers an expert opinion from an international faculty on how latest developments should influence current treatment paradigms. Areas covered: Optimal chemotherapy for first and subsequent lines of therapy; optimal management of locally advanced, non-metastatic cancer including the role of neoadjuvant chemo(radio)therapy, current evidence for adjuvant chemotherapy, major advances in pancreatic cancer genomics and challenges in supportive care particularly relevant to patients with pancreatic cancer. For each section, literature was reviewed by comprehensive search techniques, including clinical trial websites and abstracts from international cancer meetings. Expert commentary: For each section, a commentary is provided. Overall the challenges identified were: difficulties in diagnosing pancreatic cancer early, challenges for performing randomised clinical trials in all stages of the disease, some progress in systemic therapy with new agents and in identifying molecular subtypes that may be clinically relevant and move towards personalized therapy, but still, pancreatic cancer remains a very poor prognosis cancer with significant palliative care needs.

Entrepreneurship management in health services: an integrative model.

PubMed

Guo, Kristina L

2006-01-01

This research develops an integrated systems model of entrepreneurship management as a method for achieving health care organizational survival and growth. Specifically, it analyzes current health care environment challenges, identifies roles of managers and discusses organizational theories that are relevant to the health care environment, outlines the role of entrepreneurship in health care, and describes the entrepreneurial manager in the entrepreneurial management process to produce desirable organizational outcomes. The study concludes that as current health care environment continues to show intense competition, entrepreneurial managers are responsible for creating innovations, managing change, investing in resources, and recognizing opportunities in the environment to increase organizational viability.

Decision support: Vulnerability, conservation, and restoration (Chapter 8)

Treesearch

Megan M. Friggens; Jeremiah R. Pinto; R. Kasten Dumroese; Nancy L. Shaw

2012-01-01

Current predictive tools, management options, restoration paradigms, and conservation programs are insufficient to meet the challenges of climate change in western North America. Scientific and management capabilities and resources will be sapped trying to identify risks to genetic resources and ecosystems and determine new approaches for mitigating and managing...

Climate change response framework overview: Chapter 1

Treesearch

Chris Swanston; Maria Janowiak; Patricia Butler

2012-01-01

Managers currently face the immense challenge of anticipating the effects of climate change on forest ecosystems and then developing and applying management responses for adapting forests to future conditions. The Climate Change Response Framework (CCRF) is a highly collaborative approach to helping land managers understand the potential effects of climate change on...

Project management of life-science research projects: project characteristics, challenges and training needs.

PubMed

Beukers, Margot W

2011-02-01

Thirty-four project managers of life-science research projects were interviewed to investigate the characteristics of their projects, the challenges they faced and their training requirements. A set of ten discriminating parameters were identified based on four project categories: contract research, development, discovery and call-based projects--projects set up to address research questions defined in a call for proposals. The major challenges these project managers are faced with relate to project members, leadership without authority and a lack of commitment from the respective organization. Two-thirds of the project managers indicated that they would be interested in receiving additional training, mostly on people-oriented, soft skills. The training programs that are currently on offer, however, do not meet their needs. Copyright © 2010 Elsevier Ltd. All rights reserved.

Getting People Involved: The Benefit of Intellectual Capital Management for Addressing HR Challenges

ERIC Educational Resources Information Center

Pook, Katja

2011-01-01

Purpose: This paper aims to explore the benefits of intellectual capital assessment for facing current challenges of human resources work and organizational development. Design/methodology/approach: The paper takes findings of studies on challenges in HR work and maps them with features of intellectual capital assessment methods. It is thus a…

Training a Family in Physical Interventions as Part of a Positive Behaviour Support Intervention for Challenging Behaviour

ERIC Educational Resources Information Center

Hewitt, Olivia; Keeling, Natalie; Pearce, Malcom

2016-01-01

Between 10% and 15% of people with a learning disability have behaviour that challenges others, and half of these people live within the family home (Emerson et al., "Research in Developmental Disabilities," 2001; 22, 77). Current best practice in managing challenging behaviour combines person-centred planning, functional analysis, and…

Parent Perspectives on Pain Management in Preschool-Age Children With Sickle Cell Disease.

PubMed

Smith, Kelsey; Reinman, Laura; Schatz, Jeffrey; Roberts, Carla W

Pain episodes occur for many preschoolers with sickle cell disease (SCD), but little is known about parent perceptions of managing pain episodes in young children. We surveyed parents of young children with SCD who had managed pain episodes in the past year to assess their management and satisfaction with their strategies, challenges of pain management, and interest in additional education. Parents were recruited from health maintenance visits at a SCD specialty clinic. Forty-two of 51 parents (82%) of 2- to-6-year-olds reported managing pain over the past year. Parents who had managed pain primarily reported using medications. These parents reported at least moderate satisfaction with current management strategies and resources. At least one-third of parents found each facet of pain management queried as at least somewhat challenging. Identifying when their child was in pain, encouraging functional activities, and managing irritable behavior were reported as most challenging. Parents of young children with SCD reported interest in additional pain management education, which could promote better parent and child coping skills.

The ecology, restoration, and management of southeastern floodplain ecosystems: a synthesis

USGS Publications Warehouse

King, Sammy L.; Sharitz, Rebecca R.; Groninger, John W.; Battaglia, Loretta L.

2009-01-01

Floodplain ecosystems of the southeastern United States provide numerous services to society, but hydrologic and geomorphic alterations, agricultural practices, water quality and availability, and urban development continue to challenge restorationists and managers at multiple spatial and temporal scales. These challenges are further exacerbated by tremendous uncertainty regarding climate and land use patterns and natural variability in these systems. The symposium from which the papers in 2009 ensued was organized to provide a critical evaluation of current natural resource restoration and management practices to support the sustainability of floodplain ecosystem functions in the southeastern United States. In this paper we synthesize these concepts and evaluate restoration and conservation techniques in light of our understanding of these ecosystems. We also discuss current and future challenges and attempt to identify new approaches that may facilitate the long-term sustainability of southeastern floodplain systems. We conclude thatintegration of disciplines and approaches is necessary to meet the floodplain conservation challenges of the coming century. Integration will not only include purposeful dialogue between interdisciplinary natural resource professionals, but it also is necessary to sincerely engage the public about goals, objectives, and desirable outcomes of floodplain ecosystem restoration.

The ecology, restoration, and management of southeastern floodplain ecosystems: A synthesis

USGS Publications Warehouse

King, S.L.; Sharitz, R.R.; Groninger, John W.; Battaglia, Loretta L.

2009-01-01

Floodplain ecosystems of the southeastern United States provide numerous services to society, but hydrologic and geomorphic alterations, agricultural practices, water quality and availability, and urban development continue to challenge restorationists and managers at multiple spatial and temporal scales. These challenges are further exacerbated by tremendous uncertainty regarding climate and land use patterns and natural variability in these systems. The symposium from which the papers in 2009 ensued was organized to provide a critical evaluation of current natural resource restoration and management practices to support the sustainability of floodplain ecosystem functions in the southeastern United States. In this paper we synthesize these concepts and evaluate restoration and conservation techniques in light of our understanding of these ecosystems. We also discuss current and future challenges and attempt to identify new approaches that may facilitate the long-term sustainability of southeastern floodplain systems. We conclude that integration of disciplines and approaches is necessary to meet the floodplain conservation challenges of the coming century. Integration will not only include purposeful dialogue between interdisciplinary natural resource professionals, but it also is necessary to sincerely engage the public about goals, objectives, and desirable outcomes of floodplain ecosystem restoration. ?? 2009, The Society of Wetland Scientists.

Plantar Fasciitis: A Concise Review

PubMed Central

Schwartz, Emily N; Su, John

2014-01-01

One challenge in the treatment of plantar fasciitis is that very few high-quality studies exist comparing different treatment modalities to guide evidence-based management. Current literature suggests a change to the way that plantar fasciitis is managed. This article reviews the most current literature on plantar fasciitis and showcases recommended treatment guidelines. This serves to assist physicians in diagnosing and treating heel pain with plantar fasciitis. PMID:24626080

Plantar fasciitis: a concise review.

PubMed

Schwartz, Emily N; Su, John

2014-01-01

One challenge in the treatment of plantar fasciitis is that very few high-quality studies exist comparing different treatment modalities to guide evidence-based management. Current literature suggests a change to the way that plantar fasciitis is managed. This article reviews the most current literature on plantar fasciitis and showcases recommended treatment guidelines. This serves to assist physicians in diagnosing and treating heel pain with plantar fasciitis.

Dengue in the elderly: a review.

PubMed

Lin, Ray Junhao; Lee, Tau Hong; Leo, Yee Sin

2017-08-01

Changing dengue epidemiological trends have resulted in a shift in the disease burden to the adult population. Older adults suffer from poorer outcomes as compared to their younger counterparts, making clinical management of this sub-population particularly challenging. Areas covered: We present a review of the current literature on the changing epidemiology of dengue in the elderly, the atypical features of the clinical disease in this population with emphasis on severe disease presentations and challenges in the current management strategies. Expert commentary: Dengue in the elderly is an increasingly important yet greatly understudied area. There is an urgent need to refine the current diagnostic criteria to improve diagnosis, classification of disease severity and identify individuals in this population who are likely to progress to severe disease. Management strategies in this population would have to be adjusted to account for the increased number of co-morbidities. The role of the available dengue vaccines in this group is uncertain, and more studies into their safety and efficacy are critically needed.

An Ethic of Democratic, Curriculum-Based Teacher Leadership

ERIC Educational Resources Information Center

Castner, Daniel J.; Schneider, Jennifer L.; Henderson, James G.

2017-01-01

This article opens with an overview of the current policy interest in "teacher leadership" with its particular challenges and opportunities. Teacher-leader interpretations based on standardized instructional management platforms grounded in neoliberalism are critically challenged. The referent for this critical questioning is a normative…

Intercomparison of Fire Size, Fuel Loading, Fuel Consumption, and Smoke Emissions Estimates on the 2006 Tripod Fire, Washington, USA

Treesearch

Stacy A. Drury; Narasimhan Larkin; Tara T. Strand; ShihMing Huang; Scott J. Strenfel; Theresa E. O' Brien; Sean M. Raffuse

2014-01-01

Land managers rely on prescribed burning and naturally ignited wildfires for ecosystem management, and must balance trade-offs of air quality, carbon storage, and ecosystem health. A current challenge for land managers when using fire for ecosystem management is managing smoke production. Smoke emissions are a potential human health hazard due to the production of fine...

Ankle ligament injuries.

PubMed

Abbassian, Ali; Thomas, Rhidian

2008-06-01

Ankle ligament injuries in the presence or in the absence of fractures are common. They often present a diagnostic challenge, and their management is poorly understood and subject to debate. This article reviews and discusses the current literature on the management and diagnosis of these injuries.

Integrating climate change considerations into forest management tools and training

Treesearch

Linda M. Nagel; Christopher W. Swanston; Maria K. Janowiak

2010-01-01

Silviculturists are currently facing the challenge of developing management strategies that meet broad ecological and social considerations in spite of a high degree of uncertainty in future climatic conditions. Forest managers need state-of-the-art knowledge about climate change and potential impacts to facilitate development of silvicultural objectives and...

Structural Engineering Managers - Innovation Challenges for their Skills

NASA Astrophysics Data System (ADS)

Linkeschová, D.; Tichá, A.

2015-11-01

The profession of a structural engineer is highly responsible, because the consequences of a structural engineer's errors result not only in economic damage to the property and often irreversible damage to the environment, they can also lead to direct loss of lives. In the current turbulent, dynamically developing society the managerial methods of structural engineers should not stagnate at the level of the last century applications. This paper deals with the challenges which the ongoing century poses to structural engineers and managers. It compares the results of research regarding the current state of managerial skills of structural engineers in Czech building companies to the defined skills of the 21st century's managers according to the global research programme ITL Research and according to the Vision for the Future of Structural Engineering, drawn up by Structural Engineering Institute - SEI ASCE.

Cultural Sensitivity and Challenges in Management of the Transgender Patient With ESRD in Transplantation.

PubMed

Hoch, Deborah Ann; Bulman, Maya; McMahon, Dorn W

2016-03-01

Transgender patients with end-stage renal disease (ESRD) present with specific challenges during the transplant evaluation, perioperative management, and postoperative phase of care. Demographic information, health-care records, chosen name, and gender identity along with documentation of specific health-care needs can become a challenge when gender assigned at birth is incongruent with the patients gender identity. Medical care involves addressing the end-organ disease as well as addressing those aspects of care specific to the transgender patient. This review article provides information on defining transgender, the impact of ESRD, and transgender in the transplant process and considerations in the throughout phases of care. Current recommendations for management of this unique population are provided. © 2016, NATCO.

Educational Challenges of the 80's.

ERIC Educational Resources Information Center

Carroll, Constance M.

Growing conservatism, dwindling resources, and the increased diversity of students require that the California community colleges develop a plan to meet the challenges of the future. First, efforts must be made to ameliorate the current crisis in educational leadership caused by excessive concern with quantitative management techniques, reporting…

Poliovirus Studies during the Endgame of the Polio Eradication Program.

PubMed

Arita, Minetaro

2017-01-24

Since the beginning of Global Polio Eradication Initiative in 1988, poliomyelitis cases caused by wild poliovirus (PV) have been drastically reduced, with only 74 cases reported in 2 endemic countries in 2015. The current limited PV transmission suggests that we are in the endgame of the polio eradication program. However, specific challenges have emerged in the endgame, including tight budget, switching of the vaccines, and changes in biorisk management of PV. To overcome these challenges, several PV studies have been implemented in the eradication program. Some of the responses to the emerging challenges in the polio endgame might be valuable in other infectious diseases eradication programs. Here, I will review challenges that confront the polio eradication program and current research to address these challenges.

Hemorrhagic cystitis: A challenge to the urologist

PubMed Central

Manikandan, R.; Kumar, Santosh; Dorairajan, Lalgudi N.

2010-01-01

Severe hemorrhagic cystitis often arises from anticancer chemotherapy or radiotherapy for pelvic malignancies. Infectious etiologies are less common causes except in immunocompromised hosts. These cases can be challenging problems for the urologist and a source of substantial morbidity and sometimes mortality for the patients. A variety of modalities of treatment have been described for the management of hemorrhagic cystitis but there is none that is uniformly effective. Some progress has been made in the understanding and management of viral hemorrhagic cystitis. This article reviews the common causes of severe hemorrhagic cystitis and the currently available management options. PMID:20877590

Challenges in the management of community pharmacies in Malaysia

PubMed Central

2017-01-01

Background: The provision of professional pharmacy services by community pharmacists continues to be limited, particularly in low and middle income countries. It was postulated that multiple management challenges faced by community pharmacists contribute to this situation. Objective: The primary aim of the research was to determine the challenges faced in the management of community pharmacies in Sarawak (the largest state in Malaysia), and practical strategies to cope and overcome the challenges. Methods: Semi-structured interviews were carried out with community pharmacists practising in Sarawak. Purposive and snowball sampling were employed to ensure a diverse group of informants. The interviews were audio-recorded and transcribed verbatim, with the resultant data analysed using thematic analysis. Data collection, coding, interpretation were carried out iteratively until theoretical saturation. Results: Twenty respondents from different demographic characteristics were recruited. Six major themes were identified. Management challenges faced by community pharmacists traverse five major domains: market competition, legislative issues, customers’ knowledge and expectations, macroeconomic impacts and operational challenges. Most of these challenges require government intervention to be resolved. In the meantime, improving customer service and expanding the range of professional services were seen as the most viable strategies to cope with existing challenges. The main concern is that current legislative and economic landscape may hinder these strategies. Enactment of dispensing separation and more protective measures against market competition were suggested to alleviate the challenges faced. Conclusion: Numerous management challenges faced by community pharmacists that distract them from delivering professional pharmacy services have been highlighted. Urgent affirmative actions by the government are warranted in supporting community pharmacists to realise and maximise their potentials. PMID:28690697

Sexually transmitted infections: challenges ahead.

PubMed

Unemo, Magnus; Bradshaw, Catriona S; Hocking, Jane S; de Vries, Henry J C; Francis, Suzanna C; Mabey, David; Marrazzo, Jeanne M; Sonder, Gerard J B; Schwebke, Jane R; Hoornenborg, Elske; Peeling, Rosanna W; Philip, Susan S; Low, Nicola; Fairley, Christopher K

2017-08-01

WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research. In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control. Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease. The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials. Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches. STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control. Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation. Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health. Copyright © 2017 Elsevier Ltd. All rights reserved.

Exploring Interoperability as a Multidimensional Challenge for Effective Emergency Response

ERIC Educational Resources Information Center

Santisteban, Hiram

2010-01-01

Purpose. The purpose of this research was to further an understanding of how the federal government is addressing the challenges of interoperability for emergency response or crisis management (FEMA, 2009) by informing the development of standards through the review of current congressional law, commissions, studies, executive orders, and…

The Atacama Large Millimeter/Submillimeter Array (ALMA) - A Successful Three-Way International Partnership Without a Majority Stakeholder

NASA Astrophysics Data System (ADS)

Vanden Bout, Paul A.

2013-04-01

The Atacama Millimeter/Submillimeter Array (ALMA) is the largest ground-based astronomical facility built to date. It's size and challenging site required an international effort. This talk presents the partnership structure, management challenges, current status, and examples of early scientific successes.

Islam and Citizenship Education in Singapore: Challenges and Implications

ERIC Educational Resources Information Center

Tan, Charlene

2007-01-01

The religious diversity of Singapore, coupled with the current phenomenon of Islamic revivalism, makes the management of religion a paramount concern for the Singapore government. By examining the developments of Islam in Singapore, this article explores the challenges and implications these developments have on citizenship education in the…

Miles In Trail (MIT) Restrictions: A Perspective

NASA Technical Reports Server (NTRS)

Kopardekar, Parimal; Green, Steven; Roherty, Tom; Aston, John

2003-01-01

Miles-in-trail restrictions are issued to meet the airport and/or airspace capacity. The purpose of this paper is to review the currently practiced miles-in-trail operations for traffic flow management at a typical en route Air Traffic Control Center. The paper describes roles and considerations of both traffic management coordinators and the controllers in planning, coordination, execution, and monitoring of miles-in-trail restrictions. The paper addresses the type of decisions that traffic management coordinators must make and the different information required to plan and monitor miles-in-trail restrictions. The implications of miles-in-trail restrictions on controller workload are also addressed. Using the Cleveland center as an example, the paper also identified some challenging traffic situations that required miles-in-trail restrictions on a regular basis. The paper is expected to benefit the research and development community as it provides the current challenges in traffic flow management and strengths and weakness of miles-in-trail operations.

Wilderness party size regulations: implications for management and a decisionmaking framework

Treesearch

Christopher Monz; Joseph W. Roggenbuck; David N. Cole; Richard Brame; Andrew Yoder

2000-01-01

Arriving at appropriate limits on the size of groups in wilderness remains a difficult and often controversial management challenge. This paper presents a review of the state of knowledge regarding group size from an ecological impact and visitor experience standpoint, a survey of wilderness managers regarding the current status of group size regulations and a proposed...

Meeting current and future conservation challenges through the synthesis of long-term silviculture and range management research

Treesearch

Mary Beth Adams; Joe NcNeel

2010-01-01

The Experimental Forests and Ranges (EFRs) of the Forest Service, U.S. Department of Agriculture were established to represent major forest vegetation types of the United States, to provide guidelines for management of those forests and ranges, and to serve as "outdoor classrooms" for land managers to learn how to better manage their forests. Research data...

Two Ways to Support Reflexivity: Teaching Managers to Fulfil an Undefined Role

ERIC Educational Resources Information Center

Adriansen, Hanne Kirstine; Knudsen, Hanne

2013-01-01

A current challenge to public managers is the lack of a well-defined role. How can masters programmes prepare managers to live up to an undefined function? In this paper we argue that the lack of role description enhances the need for reflexivity and we show how it is done at Master in Educational Management (MEM). MEM provides the participating…

Paying for disease management.

PubMed

Levy, Phillip; Nocerini, Robert; Grazier, Kyle

2007-08-01

Disease Management (DM) first appeared in the United States in the early 1990s. Since then its incorporation into health plans has increased dramatically, yet proof of its effectiveness in terms of quality improvement and cost reduction remains to be seen. The following review provides an exploratory analysis of the basic principles of DM, its evolution and differences from traditional managed care, the ways in which programs are currently being used in the private and public sectors, and the challenges to determining a payment structure for incorporating DM into the current health insurance system.

Micro-Scale Avionics Thermal Management

NASA Technical Reports Server (NTRS)

Moran, Matthew E.

2001-01-01

Trends in the thermal management of avionics and commercial ground-based microelectronics are converging, and facing the same dilemma: a shortfall in technology to meet near-term maximum junction temperature and package power projections. Micro-scale devices hold the key to significant advances in thermal management, particularly micro-refrigerators/coolers that can drive cooling temperatures below ambient. A microelectromechanical system (MEMS) Stirling cooler is currently under development at the NASA Glenn Research Center to meet this challenge with predicted efficiencies that are an order of magnitude better than current and future thermoelectric coolers.

Healthcare waste management: current practices in selected healthcare facilities, Botswana.

PubMed

Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

2008-01-01

Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings.

PubMed

Graham, Stephen M; English, Mike; Hazir, Tabish; Enarson, Penny; Duke, Trevor

2008-05-01

Effective case management is an important strategy to reduce pneumonia-related morbidity and mortality in children. Guidelines based on sound evidence are available but are used variably. This review outlines current guidelines for childhood pneumonia management in the setting where most child pneumonia deaths occur and identifies challenges for improved management in a variety of settings and different "at-risk" groups. These include appropriate choice of antibiotic, clinical overlap with other conditions, prompt and appropriate referral for inpatient care, and management of treatment failure. Management of neonates, and of HIV-infected or severely malnourished children is more complicated. The influence of co-morbidities on pneumonia outcome means that pneumonia case management must be integrated within strategies to improve overall paediatric care. The greatest potential for reducing pneumonia-related deaths in health facilities is wider implementation of the current guidelines built around a few core activities: training, antibiotics and oxygen. This requires investment in human resources and in equipment for the optimal management of hypoxaemia. It is important to provide data from a variety of epidemiological settings for formal cost-effectiveness analyses. Improvements in the quality of case management of pneumonia can be a vehicle for overall improvements in child health-care practices.

Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland.

PubMed

Carney, Marie

2010-07-01

The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring. Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times. Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the study's aim. Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money. In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices. As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.

Challenges and opportunities in healthcare volunteer management: insights from volunteer administrators.

PubMed

Rogers, Sean E; Rogers, Carmen M; Boyd, Karen D

2013-01-01

Volunteer administrators from 105 hospitals in five states in the northeast and southern United States provided open-ended survey responses about what they perceived to be the most pressing challenges and opportunities facing healthcare volunteer management. Taken together, these 105 hospitals used a total of 39,008 volunteers and 5.3 million volunteer hours during a 12-month period between 2010 and 2011. A qualitative content analysis of administrator responses suggests that primary challenges include volunteer recruitment and retention, administrative issues, and operational difficulties brought about by the current economic crisis. Key opportunities include more explicitly linking the volunteer function to hospital outcomes and community impact, expanding volunteer recruitment pools and roles and jobs, and developing organizational support for volunteers and making the volunteer management function more efficient and effective.

BRIDGING THE SCIENCE-MANAGEMENT DIVIDE: MOVING FROM UNIDIRECTIONAL KNOWLEDGE TRANSFER TO KNOWLEDGE INTERFACING AND SHARING

EPA Science Inventory

Sustainable ecosystem management relies on a diverse and multi-faceted knowledge system in which techniques are continuously updated to reflect current understanding and needs. The challenge is to minimize delay as ideas flow from intent through scientific capability, and finally...

A Streamlined Monitoring Framework for Sustainable and Low Impact Development Stormwater Management Practices - 2

EPA Science Inventory

The problems of urbanization and stormwater management, as they pertain to monitoring the condition of water and environmental resources, are grounded in issues of scale, connectivity, temporal and non-linear change. Given our current understanding of these issues, the challenge ...

Important, misunderstood, and challenging: a qualitative study of nurses' and allied health professionals' perceptions of implementing self-management for patients with COPD.

PubMed

Young, Hannah M L; Apps, Lindsay D; Harrison, Samantha L; Johnson-Warrington, Vicki L; Hudson, Nicky; Singh, Sally J

2015-01-01

In light of the growing burden of COPD, there is increasing focus on the role of self-management for this population. Currently, self-management varies widely. Little is known either about nurses' and allied health professionals' (AHPs') understanding and provision of self-management in clinical practice. This study explores nurses' and AHPs' understanding and implementation of supported COPD self-management within routine clinical practice. Nurses and AHPs participated in face-to-face semistructured interviews to explore their understanding and provision of COPD self-management, as well as their perceptions of the challenges to providing such care. Purposive sampling was used to select participants from a range of professions working within primary, community, and secondary care settings. Three researchers independently analyzed each transcript using a thematic approach. A total of 14 participants were interviewed. Nurses and AHPs viewed self-management as an important aspect of COPD care, but often misunderstood what it involved, leading to variation in practice. A number of challenges to supporting self-management were identified, which related to lack of time, lack of insight regarding training needs, and assumptions regarding patients' perceived self-management abilities. Nurses and AHPs delivering self-management require clear guidance, training in the use of effective self-management skills, and education that challenges their preconceptions regarding patients. The design of health care services also needs to consider the practical barriers to COPD self-management support for the implementation of such interventions to be successful.

Towards the effective plastic waste management in Bangladesh: a review.

PubMed

Mourshed, Monjur; Masud, Mahadi Hasan; Rashid, Fazlur; Joardder, Mohammad Uzzal Hossain

2017-12-01

The plastic-derived product, nowadays, becomes an indispensable commodity for different purposes. A huge amount of used plastic causes environmental hazards that turn in danger for marine life, reduces the fertility of soil, and contamination of ground water. Management of this enormous plastic waste is challenging in particular for developing countries like Bangladesh. Lack of facilities, infrastructure development, and insufficient budget for waste management are some of the prime causes of improper plastic management in Bangladesh. In this study, the route of plastic waste production and current plastic waste management system in Bangladesh have been reviewed extensively. It emerges that no technical and improved methods are adapted in the plastic management system. A set of the sustainable plastic management system has been proposed along with the challenges that would emerge during the implementation these strategies. Successful execution of the proposed systems would enhance the quality of plastic waste management in Bangladesh and offers enormous energy from waste.

Factors Influencing the Use of Psychotropic Medication for Challenging Behaviour in the United Kingdom: A Q Method Investigation

ERIC Educational Resources Information Center

Wastell, Sarah; Skirrow, Paul; Hare, Dougal Julian

2016-01-01

Objectives: The use of pharmacological interventions to manage challenging behaviour displayed by adults with intellectual disabilities remains controversial, with current clinical guidelines in the United Kingdom advocating the use of less invasive psychological interventions. This exploratory study aimed to discover what views and beliefs are…

Leadership in Continuing and Distance Education in Higher Education.

ERIC Educational Resources Information Center

Shoemaker, Cynthia C. Jones

This book provides a framework for leadership in the combined fields of higher education, management, and marketing. It is divided into three sections. Section 1, "Challenges and Changes in Continuing Education," has two chapters identifying some of the current challenges. Section 2, "Leadership for the 21st Century in Continuing Education," has…

The NASA Risk Management Program

NASA Technical Reports Server (NTRS)

Buchbinder, Benjamin

1990-01-01

This paper describes the NASA Risk Management Program established by the Headquarters Office of Safety and Mission Quality (MSQ). Current agency policy is outlined, risk management assistance to the field is described, and examples are given of independent risk assessments conducted by SMQ. The motivation for and the structure of the program is placed in the historical context of pre- and post-Challenger environments.

Adapting Project Management Practices to Research-Based Projects

NASA Technical Reports Server (NTRS)

Bahr, P.; Baker, T.; Corbin, B.; Keith, L.; Loerch, L.; Mullenax, C.; Myers, R.; Rhodes, B.; Skytland, N.

2007-01-01

From dealing with the inherent uncertainties in outcomes of scientific research to the lack of applicability of current NASA Procedural Requirements guidance documentation, research-based projects present challenges that require unique application of classical project management techniques. If additionally challenged by the creation of a new program transitioning from basic to applied research in a technical environment often unfamiliar with the cost and schedule constraints addressed by project management practices, such projects can find themselves struggling throughout their life cycles. Finally, supplying deliverables to a prime vehicle customer, also in the formative stage, adds further complexity to the development and management of research-based projects. The Biomedical Research and Countermeasures Projects Branch at NASA Johnson Space Center encompasses several diverse applied research-based or research-enabling projects within the newly-formed Human Research Program. This presentation will provide a brief overview of the organizational structure and environment in which these projects operate and how the projects coordinate to address and manage technical requirements. We will identify several of the challenges (cost, technical, schedule, and personnel) encountered by projects across the Branch, present case reports of actions taken and techniques implemented to deal with these challenges, and then close the session with an open forum discussion of remaining challenges and potential mitigations.

Forest management in Northeast China: history, problems, and challenges.

PubMed

Yu, Dapao; Zhou, Li; Zhou, Wangming; Ding, Hong; Wang, Qingwei; Wang, Yue; Wu, Xiaoqing; Dai, Limin

2011-12-01

Studies of the history and current status of forest resources in Northeast China have become important in discussions of sustainable forest management in the region. Prior to 1998, excessive logging and neglected cultivation led to a series of problems that left exploitable forest reserves in the region almost exhausted. A substantial decrease in the area of natural forests was accompanied by severe disruption of stand structure and serious degradation of overall forest quality and function. In 1998, China shifted the primary focus of forest management in the country from wood production to ecological sustainability, adopting ecological restoration and protection as key foci of management. In the process, China launched the Natural Forest Conversion Program and implemented a new system of Classification-based Forest Management. Since then, timber harvesting levels in Northeast China have decreased, and forest area and stocking levels have slowly increased. At present, the large area of low quality secondary forest lands, along with high levels of timber production, present researchers and government agencies in China with major challenges in deciding on management models and strategies that will best protect, restore and manage so large an area of secondary forest lands. This paper synthesizes information from a number of sources on forest area, stand characteristics and stocking levels, and forest policy changes in Northeastern China. Following a brief historical overview of forest harvesting and ecological research in Northeast China, the paper discusses the current state of forest resources and related problems in forest management in the region, concluding with key challenges in need of attention in order to meet the demands for multi-purpose forest sustainability and management in the future.

Historical and Current Trends in Colon Trauma

PubMed Central

Causey, Marlin Wayne; Rivadeneira, David E.; Steele, Scott R.

2012-01-01

The authors discuss the evolution of the evaluation and management of colonic trauma, as well as the debate regarding primary repair versus fecal diversion. Their evidence-based review covers diagnosis, management, surgical approaches, and perioperative care of patients with colon-related trauma. The management of traumatic colon injuries has evolved significantly over the past 50 years; here the authors describe a practical approach to the treatment and management of traumatic injuries to the colon based on the most current research. However, management of traumatic colon injuries remains a challenge and continues to be associated with significant morbidity. Familiarity with the different methods to the approach and management of colonic injuries will allow surgeons to minimize unnecessary complications and mortality. PMID:24294119

Humor in the Workplace: A Communication Challenge.

ERIC Educational Resources Information Center

Vartabedian, Robert A.; Vartabedian, Laurel Klinger

This paper examines some of the various findings contained in the current literature on humor in the workplace. In recent years, the communicative role of humor in the workplace has received attention--particularly in management-related publications. Consequently, the paper explores the emergence of humor as a management tool and the advantages…

The Paperwork Reduction Act of 1995: A Second Chance for Information Resources Management.

ERIC Educational Resources Information Center

Plocher, David

1996-01-01

Reviews the origins of information resources management (IRM) in the Paperwork Reduction Act of 1980, the Act's implementation and its 1995 reauthorization of appropriations, and current challenges confronting IRM. Discusses linking IRM to program performance, clarifying roles to improve accountability, and the integration of access and…

Funding strategies for wilderness management

Treesearch

Carolyn Alkire

2000-01-01

Funding wilderness protection will continue to be a challenge for public land managers. With continuing competition for federal funds and balanced budget goals, other sources of funds may be necessary to supplement annual federal appropriations. This paper identifies and evaluates five potential funding strategies and provides examples of each that are currently in use...

A systems approach for management of pests and pathogens of nursery crops

Treesearch

Jennifer L. Parke; Niklaus J. Grünwald

2012-01-01

Horticultural nurseries are heterogeneous and spatially complex agricultural systems, which present formidable challenges to management of diseases and pests. Moreover, nursery plants shipped interstate and internationally can serve as important vectors for pathogens and pests that threaten both agriculture and forestry. Current regulatory strategies to prevent this...

Personal wilderness relationships: Building on a transactional approach

Treesearch

Robert G. Dvorak; William T. Borrie; Alan E. Watson

2013-01-01

Wilderness managers are charged with the challenging goal of balancing resource protection and experience quality across a broad, value-laden landscape. While research has provided insight into visitors' motivations and their meanings for wilderness, a struggle exists to implement experiential concepts within current management frameworks. This research posits the...

Tips for Dealing with Behavior Management Issues

ERIC Educational Resources Information Center

Bechtel, Pamela A.; Stevens, Lisa A.; Brett, Christine E. W.

2012-01-01

The increased diversity of today's students included in P-12 physical education classes creates new challenges in behavior management for physical education teachers. Currently more students with identified at-risk behaviors, as well as more students with physical or mental disabilities, are placed in general physical education classes. This…

"I Love Fruit But I Can't Afford It": Using Participatory Action Research to Develop Community-Based Initiatives to Mitigate Challenges to Chronic Disease Management in an African American Community Living in Public Housing.

PubMed

Rogers, Courtney; Johnson, Joy; Nueslein, Brianne; Edmunds, David; Valdez, Rupa S

2018-03-12

As chronic conditions are on the rise in the USA, management initiatives outside of the inpatient setting should be explored to reduce associated cost and access disparities. Chronic conditions disproportionately affect African American public housing residents due to the effects of historical marginalization on the manifestation of economic and social problems exacerbating health disparities and outcomes. Informed by participatory research action tenets, this study focused on identifying the challenges to management of chronic conditions and developing community-envisioned initiatives to address these challenges in a predominantly African American public housing community. Two focus groups were conducted with former and current public housing residents and were analyzed using inductive content analysis. Physical activity, the cost associated with healthy eating, and lack of information were noted as challenges to chronic disease management. Initiatives discussed were the formation of a walking partner's program to promote physical activity, a shopper's club to exchange coupons and learn how to prepare healthy meals, and a natural remedy's book to share information intergenerationally about management tactics. Challenges identified existed predominantly on the individual and the system level, while the initiatives generated target engaging interpersonal and community relationships. These community-envisioned approaches should be explored to facilitate chronic disease management in public housing neighborhoods.

Managing for climate change on protected areas: An adaptive management decision making framework.

PubMed

Tanner-McAllister, Sherri L; Rhodes, Jonathan; Hockings, Marc

2017-12-15

Current protected area management is becoming more challenging with advancing climate change and current park management techniques may not be adequate to adapt for effective management into the future. The framework presented here provides an adaptive management decision making process to assist protected area managers with adapting on-park management to climate change. The framework sets out a 4 step process. One, a good understanding of the park's context within climate change. Secondly, a thorough understanding of the park management systems including governance, planning and management systems. Thirdly, a series of management options set out as an accept/prevent change style structure, including a systematic assessment of those options. The adaptive approaches are defined as acceptance of anthropogenic climate change impact and attempt to adapt to a new climatic environment or prevention of change and attempt to maintain current systems under new climatic variations. Last, implementation and monitoring of long term trends in response to ecological responses to management interventions and assessing management effectiveness. The framework addresses many issues currently with park management in dealing with climate change including the considerable amount of research focussing on 'off-reserve' strategies, and threats and stress focused in situ park management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Insights of health district managers on the implementation of primary health care outreach teams in Johannesburg, South Africa: a descriptive study with focus group discussions.

PubMed

Moosa, Shabir; Derese, Anselme; Peersman, Wim

2017-01-21

Primary health care (PHC) outreach teams are part of a policy of PHC re-engineering in South Africa. It attempts to move the deployment of community health workers (CHWs) from vertical programmes into an integrated generalised team-based approach to care for defined populations in municipal wards. There has little evaluation of PHC outreach teams. Managers' insights are anecdotal. This is descriptive qualitative study with focus group discussions with health district managers of Johannesburg, the largest city in South Africa. This was conducted in a sequence of three meetings with questions around implementation, human resources, and integrated PHC teamwork. There was a thematic content analysis of validated transcripts using the framework method. There were two major themes: leadership-management challenges and human resource challenges. Whilst there was some positive sentiment, leadership-management challenges loomed large: poor leadership and planning with an under-resourced centralised approach, poor communications both within the service and with community, concerns with its impact on current services and resistance to change, and poor integration, both with other streams of PHC re-engineering and current district programmes. Discussion by managers on human resources was mostly on the plight of CHWs and calls for formalisation of CHWs functioning and training and nurse challenges with inappropriate planning and deployment of the team structure, with brief mention of the extended team. Whilst there is positive sentiment towards intent of the PHC outreach team, programme managers in Johannesburg were critical of management of the programme in their health district. Whilst the objective of PHC reform is people-centred health care, its implementation struggles with a centralising tendency amongst managers in the health service in South Africa. Managers in Johannesburg advocated for decentralisation. The implementation of PHC outreach teams is also limited by difficulties with formalisation and training of CHWs and appropriate task shifting to nurses. Change management is required to create true integrate PHC teamwork. Policy review requires addressing these issues.

Information management challenges of the EOS Data and Information System

NASA Technical Reports Server (NTRS)

Mcdonald, Kenneth R.; Blake, Deborah J.

1991-01-01

An overview of the current information management concepts that are embodied in the plans for the Earth Observing System Data and Information System (EOSDIS) is presented, and some of the technology development and application areas that are envisioned to be particularly challenging are introduced. The Information Management System (IMS) is the EOSDIS element that provides the primary interface between the science users and the data products and services of EOSDIS. The goals of IMS are to define a clear and complete set of functional requirements and to apply innovative methods and technologies to satisfy them. The information management functions are described in detail, and some applicable technolgies are discussed. Some of the general issues affecting the successful development and operation of the information management element are addressed.

A ten-step process to develop case management plans.

PubMed

Tahan, Hussein A

2002-01-01

The use of case management plans has contained cost and improved quality of care successfully. However, the process of developing these plans remains a great challenge for healthcare executives, in this article, the author presents the answer to this challenge by discussing a 10-step formal process that administrators of patient care services and case managers can adapt to their institutions. It also can be used by interdisciplinary team members as a practical guide to develop a specific case management plan. This process is applicable to any care setting (acute, ambulatory, long term, and home care), diagnosis, or procedure. It is particularly important for those organizations that currently do not have a deliberate and systematic process to develop case management plans and are struggling with how to improve the efficiency and productivity of interdisciplinary teams charged with developing case management plans.

Implementing a Nurse Manager Profile to Improve Unit Performance.

PubMed

Krugman, Mary E; Sanders, Carolyn L

2016-06-01

Nurse managers face significant pressures in the rapidly changing healthcare environment. Staying current with multiple sources of data, including reports that detail institutional and unit performance outcomes, is particularly challenging. A Nurse Manager Customized Profile was developed at a western academic hospital to provide a 1-page visual of pertinent data to help managers and director supervisors focus coaching to improve unit performance. Use of the Decisional Involvement Scale provided new insights into measuring manager performance.

Integrated Risk and Knowledge Management Program -- IRKM-P

NASA Technical Reports Server (NTRS)

Lengyel, David M.

2009-01-01

The NASA Exploration Systems Mission Directorate (ESMD) IRKM-P tightly couples risk management and knowledge management processes and tools to produce an effective "modern" work environment. IRKM-P objectives include: (1) to learn lessons from past and current programs (Apollo, Space Shuttle, and the International Space Station); (2) to generate and share new engineering design, operations, and management best practices through preexisting Continuous Risk Management (CRM) procedures and knowledge-management practices; and (3) to infuse those lessons and best practices into current activities. The conceptual framework of the IRKM-P is based on the assumption that risks highlight potential knowledge gaps that might be mitigated through one or more knowledge management practices or artifacts. These same risks also serve as cues for collection of knowledge particularly, knowledge of technical or programmatic challenges that might recur.

Assessment of human resources management practices in Lebanese hospitals.

PubMed

El-Jardali, Fadi; Tchaghchagian, Victoria; Jamal, Diana

2010-01-01

Sound human resources (HR) management practices are essential for retaining effective professionals in hospitals. Given the recruitment and retention reality of health workers in the twenty-first century, the role of HR managers in hospitals and those who combine the role of HR managers with other responsibilities should not be underestimated. The objective of this study is to assess the perception of HR managers about the challenges they face and the current strategies being adopted. The study also aims at assessing enabling factors including role, education, experience and HR training. A cross-sectional survey design of HR managers (and those who combine their role as HR manager with other duties) in Lebanese hospitals was utilized. The survey included a combination of open- and close-ended questions. Questions included educational background, work experience, and demographics, in addition to questions about perceived challenges and key strategies being used. Quantitative data analysis included uni-variate analysis, whereas thematic analysis was used for open-ended questions. A total of 96 respondents from 61 hospitals responded. Respondents had varying levels of expertise in the realm of HR management. Thematic analysis revealed that challenges varied across respondents and participating hospitals. The most frequently reported challenge was poor employee retention (56.7%), lack of qualified personnel (35.1%), and lack of a system for performance evaluation (28.9%). Some of the strategies used to mitigate the above challenges included offering continuing education and training for employees (19.6%), improving salaries (14.4%), and developing retention strategies (10.3%). Mismatch between reported challenges and strategies were observed. To enable hospitals to deliver good quality, safe healthcare, improving HR management is critical. There is a need for a cadre of competent HR managers who can fully assume these responsibilities and who can continuously improve the status of employees at their organizations. The upcoming accreditation survey of Lebanese hospitals (2010-2011) presents an opportunity to strengthen HR management and enhance competencies of existing HR managers. Recognizing HR challenges and the importance of effective HR strategies should become a priority to policy-makers and top managers alike. Study findings may extend to other countries in the Eastern Mediterranean region.

Assessment of human resources management practices in Lebanese hospitals.

PubMed

El-Jardali, Fadi; Tchaghchagian, Victoria; Jamal, Diana

2009-11-12

Sound human resources (HR) management practices are essential for retaining effective professionals in hospitals. Given the recruitment and retention reality of health workers in the twenty-first century, the role of HR managers in hospitals and those who combine the role of HR managers with other responsibilities should not be underestimated. The objective of this study is to assess the perception of HR managers about the challenges they face and the current strategies being adopted. The study also aims at assessing enabling factors including role, education, experience and HR training. A cross-sectional survey design of HR managers (and those who combine their role as HR manager with other duties) in Lebanese hospitals was utilized. The survey included a combination of open- and close-ended questions. Questions included educational background, work experience, and demographics, in addition to questions about perceived challenges and key strategies being used. Quantitative data analysis included uni-variate analysis, whereas thematic analysis was used for open-ended questions. A total of 96 respondents from 61 hospitals responded. Respondents had varying levels of expertise in the realm of HR management. Thematic analysis revealed that challenges varied across respondents and participating hospitals. The most frequently reported challenge was poor employee retention (56.7%), lack of qualified personnel (35.1%), and lack of a system for performance evaluation (28.9%). Some of the strategies used to mitigate the above challenges included offering continuing education and training for employees (19.6%), improving salaries (14.4%), and developing retention strategies (10.3%). Mismatch between reported challenges and strategies were observed. To enable hospitals to deliver good quality, safe healthcare, improving HR management is critical. There is a need for a cadre of competent HR managers who can fully assume these responsibilities and who can continuously improve the status of employees at their organizations. The upcoming accreditation survey of Lebanese hospitals (2010-2011) presents an opportunity to strengthen HR management and enhance competencies of existing HR managers. Recognizing HR challenges and the importance of effective HR strategies should become a priority to policy makers and top managers alike. Study findings may extend to other countries in the Eastern Mediterranean region.

Assessment of human resources management practices in Lebanese hospitals

PubMed Central

2009-01-01

Background Sound human resources (HR) management practices are essential for retaining effective professionals in hospitals. Given the recruitment and retention reality of health workers in the twenty-first century, the role of HR managers in hospitals and those who combine the role of HR managers with other responsibilities should not be underestimated. The objective of this study is to assess the perception of HR managers about the challenges they face and the current strategies being adopted. The study also aims at assessing enabling factors including role, education, experience and HR training. Methods A cross-sectional survey design of HR managers (and those who combine their role as HR manager with other duties) in Lebanese hospitals was utilized. The survey included a combination of open- and close-ended questions. Questions included educational background, work experience, and demographics, in addition to questions about perceived challenges and key strategies being used. Quantitative data analysis included uni-variate analysis, whereas thematic analysis was used for open-ended questions. Results A total of 96 respondents from 61 hospitals responded. Respondents had varying levels of expertise in the realm of HR management. Thematic analysis revealed that challenges varied across respondents and participating hospitals. The most frequently reported challenge was poor employee retention (56.7%), lack of qualified personnel (35.1%), and lack of a system for performance evaluation (28.9%). Some of the strategies used to mitigate the above challenges included offering continuing education and training for employees (19.6%), improving salaries (14.4%), and developing retention strategies (10.3%). Mismatch between reported challenges and strategies were observed. Conclusion To enable hospitals to deliver good quality, safe healthcare, improving HR management is critical. There is a need for a cadre of competent HR managers who can fully assume these responsibilities and who can continuously improve the status of employees at their organizations. The upcoming accreditation survey of Lebanese hospitals (2010-2011) presents an opportunity to strengthen HR management and enhance competencies of existing HR managers. Recognizing HR challenges and the importance of effective HR strategies should become a priority to policy makers and top managers alike. Study findings may extend to other countries in the Eastern Mediterranean region. PMID:19909527

Caring for people with dementia and challenging behaviors in nursing homes: A needs assessment geriatric nursing.

PubMed

Daly, Jeanette M; Bay, Camden P; Levy, Barcey T; Carnahan, Ryan M

2015-01-01

An estimated 50% of nursing home residents have a dementia diagnosis. The purpose of this research was to conduct a needs assessment of directors of nursing (DON) in Iowa nursing homes in relation to caring for patients with Behavioral and Psychological Symptoms of Dementia. DON responses were linked to Online Survey Certification and Reporting/Certification and Survey Provider Enhanced Reporting (OSCAR/CASPER) data to examine how facility characteristics may be associated with use of and confidence in non-drug management strategies. From 431 questionnaires mailed to DONs, 160 (37%) were returned. Regression analysis showed that those who were more confident in managing challenging behavior were more likely to have satisfaction with current training on managing challenging behaviors and had a psychiatrist available to visit the facility. Facilities with a larger proportion of patients with challenging behaviors being treated with non-drug approaches instead of antipsychotics had DONs who were more likely to be confident in non-drug management strategies and have knowledge about the FDA antipsychotic medications risks. Copyright © 2015 Elsevier Inc. All rights reserved.

Optimising the management of severe Traumatic Brain Injury in the military maritime environment.

PubMed

Edgar, I A; Hadjipavlou, G; Smith, J E

2014-01-01

Severe Traumatic Brain Injury (sTBI) is a devastating cause of morbidity and mortality, especially among those aged less than 45 years. Advances in clinical practice continue to focus on preventing primary injury through developing ballistic head and eye protection, and through minimising secondary brain injury (secondary prevention). Managing sTBI is challenging in well-developed, well-resourced healthcare systems. Achieving management aims in the military maritime environment poses even greater challenges. Strategies for the management of sTBI in the maritime environment should be in keeping with current best evidence. Provision of specialist interventions for sTBI in military maritime environments may require alternative approaches matched to the skills of the staff and environmental restrictions.

Specialty pharmacy cost management strategies of private health care payers.

PubMed

Stern, Debbie; Reissman, Debi

2006-01-01

The rate of increase in spending on specialty pharmaceuticals is outpacing by far the rate of increase in spending for other drugs. To explore the strategies payers are using in response to challenges related to coverage, cost, clinical management, and access of specialty pharmaceuticals and to describe the potential implications for key stakeholders, including patients, physicians, and health care purchasers. Sources of information were identified in the course of providing consulting services in the subject area of specialty pharmaceuticals to health plans, pharmacy benefit managers, employers, and pharmaceutical manufacturers. Specialty pharmaceuticals represent the fastest growing segment of drug spending due to new product approvals, high unit costs, and increasing use. Health care payers are faced with significant challenges related to coverage, cost, clinical management, and access. A variety of short- and long-term strategies have been employed to address these challenges. Current management techniques for specialty pharmaceuticals often represent a stop-gap approach for controlling rising drug costs. Optimum cost and care management methods will evolve as further research identifies the true clinical and economic value of various specialty pharmaceuticals.

Federal health web sites: current & future roles.

PubMed

Cronin, Carol

2002-09-01

An examination of the current and possible future roles of federal health Web sites, this paper provides an overview of site categories, functions, target audiences, marketing approaches, knowledge management, and evaluation strategies. It concludes with a look at future opportunities and challenges for the federal government in providing health information online.

Acute cyanide poisoning in prehospital care: new challenges, new tools for intervention.

PubMed

Guidotti, Tee

2006-01-01

Effective management of cyanide poisoning from chemical terrorism, inhalation of fire smoke, and other causes constitutes a critical challenge for the prehospital care provider. The ability to meet the challenge of managing cyanide poisoning in the prehospital setting may be enhanced by the availability of the cyanide antidote hydroxocobalamin, currently under development for potential introduction in the United States. This paper discusses the causes, recognition, and management of acute cyanide poisoning in the prehospital setting with emphasis on the emerging profile of hydroxocobalamin, an antidote that may have a risk:benefit ratio suitable for empiric, out-of-hospital treatment of the range of causes of cyanide poisoning. If introduced in the U.S., hydroxocobalamin may enhance the role of the U.S. prehospital responder in providing emergency care in a cyanide incident.

Computing in high-energy physics

DOE PAGES

Mount, Richard P.

2016-05-31

I present a very personalized journey through more than three decades of computing for experimental high-energy physics, pointing out the enduring lessons that I learned. This is followed by a vision of how the computing environment will evolve in the coming ten years and the technical challenges that this will bring. I then address the scale and cost of high-energy physics software and examine the many current and future challenges, particularly those of management, funding and software-lifecycle management. Lastly, I describe recent developments aimed at improving the overall coherence of high-energy physics software.

Computing in high-energy physics

NASA Astrophysics Data System (ADS)

Mount, Richard P.

2016-04-01

I present a very personalized journey through more than three decades of computing for experimental high-energy physics, pointing out the enduring lessons that I learned. This is followed by a vision of how the computing environment will evolve in the coming ten years and the technical challenges that this will bring. I then address the scale and cost of high-energy physics software and examine the many current and future challenges, particularly those of management, funding and software-lifecycle management. Finally, I describe recent developments aimed at improving the overall coherence of high-energy physics software.

Computing in high-energy physics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mount, Richard P.

I present a very personalized journey through more than three decades of computing for experimental high-energy physics, pointing out the enduring lessons that I learned. This is followed by a vision of how the computing environment will evolve in the coming ten years and the technical challenges that this will bring. I then address the scale and cost of high-energy physics software and examine the many current and future challenges, particularly those of management, funding and software-lifecycle management. Lastly, I describe recent developments aimed at improving the overall coherence of high-energy physics software.

Management of Primary Adrenal Insufficiency: Review of Current Clinical Practice in a Developed and a Developing Country.

PubMed

Khan, Uzma; Lakhani, Om J

2017-01-01

Treatment of primary adrenal insufficiency (PAI) requires lifelong hormone replacement with glucocorticoids (GCs) and mineralocorticoids. Impaired quality of life and increased standardized mortality ratio in these patients emphasize the importance of tailoring therapy to individual needs. Role of education is paramount in improving patient compliance and in anticipating and preventing adrenal crises. Although discovery of synthetic GCs was a major breakthrough in treatment of patients with this life-threatening condition, management of PAI continues to be challenging. The obstacles for clinicians appear to vary widely across the globe. While optimization and individualization of therapy after diagnosis of PAI remain the main challenges for clinicians in the developed world, doctors in a developing country face problems at almost every stage from the diagnosis to the treatment and follow-up of these patients; cost of therapy, lack of resources, and funding are the main hindrances. Adherence to therapy and patient education are found to be common issues in most parts of the world. This commentary highlights the challenges from both developed and developing country's perspective in treating PAI; it also provides an update on current management scenario and future treatment options.

Is there a prospect for hybrid aortic arch surgery?

PubMed

Bashir, Mohamad; Harky, Amer; Bilal, Haris

2018-05-16

The surge of endovascular repair of aortic aneurysm in current modern aortic surgery practice has been the key for surgical management of elective cases of thoracic aortic aneurysms. This has paved way for the combined hybrid approach to be amongst the armamentarium for the management of aortic arch disease. The pivotal understanding of the aortic arch natural history coupled with device technology advancement allowed surgeons insight into delivery of hybrid surgery with acceptable morbidity and mortality results. This review article provides current insights into hybrid technique of aortic arch aneurysm repair and the evidences behind its applicability to arch surgery. It is aimed to highlight the challenges encountered for this innovative approach and correlate its challenges to those that are met by the conventional open aortic arch repair.

Ocean Science Video Challenge Aims to Improve Science Communication

NASA Astrophysics Data System (ADS)

Showstack, Randy

2013-10-01

Given today's enormous management and protection challenges related to the world's oceans, a new competition calls on ocean scientists to effectively communicate their research in videos that last up to 3 minutes. The Ocean 180 Video Challenge, named for the number of seconds in 3 minutes, aims to improve ocean science communication while providing high school and middle school teachers and students with new and interesting educational materials about current science topics.

Social science findings in the United States

Treesearch

Sarah McCaffrey; Eric Toman; Melanie Stidham; Bruce Shindler

2015-01-01

The rising number of acres burned annually and growing number of people living in or adjacent to fire-prone areas in the United States make wildfire management an increasingly complex and challenging problem. Given the prominence of social issues in shaping the current challenges and determining paths forward, it will be important to have an accurate understanding of...

Implementing principles of the integrated control concept 50 years later – current challenges in IPM for arthropod pests

USDA-ARS?s Scientific Manuscript database

Pest management theory and concepts developed fifty years ago as part of the integrated control concept remain at the foundation of IPM today. Implementation of integrated control and subsequently IPM has always been faced with the challenge of carrying out their principles in a rigorous, disciplin...

The Evolution of Teleophthalmology Programs in the United Kingdom: Beyond Diabetic Retinopathy Screening.

PubMed

Sim, Dawn A; Mitry, Danny; Alexander, Philip; Mapani, Adam; Goverdhan, Srini; Aslam, Tariq; Tufail, Adnan; Egan, Catherine A; Keane, Pearse A

2016-02-01

Modern ophthalmic practice in the United Kingdom is faced by the challenges of an aging population, increasing prevalence of systemic pathologies with ophthalmic manifestations, and emergent treatments that are revolutionary but dependent on timely monitoring and diagnosis. This represents a huge strain not only on diagnostic services but also outpatient management and surveillance capacity. There is an urgent need for newer means of managing this surge in demand and the socioeconomic burden it places on the health care system. Concurrently, there have been exponential increases in computing power, expansions in the strength and ubiquity of communications technologies, and developments in imaging capabilities. Advances in imaging have been not only in terms of resolution, but also in terms of anatomical coverage, allowing new inferences to be made. In spite of this, image analysis techniques are still currently superseded by expert ophthalmologist interpretation. Teleophthalmology is therefore currently perfectly placed to face this urgent and immediate challenge of provision of optimal and expert care to remote and multiple patients over widespread geographical areas. This article reviews teleophthalmology programs currently deployed in the United Kingdom, focusing on diabetic eye care but also discussing glaucoma, emergency eye care, and other retinal diseases. We examined current programs and levels of evidence for their utility, and explored the relationships between screening, teleophthalmology, disease detection, and monitoring before discussing aspects of health economics pertinent to diabetic eye care. The use of teleophthalmology presents an immense opportunity to manage the steadily increasing demand for eye care, but challenges remain in the delivery of practical, viable, and clinically proven solutions. © 2016 Diabetes Technology Society.

The Evolution of Teleophthalmology Programs in the United Kingdom

PubMed Central

Sim, Dawn A.; Mitry, Danny; Alexander, Philip; Mapani, Adam; Goverdhan, Srini; Aslam, Tariq; Tufail, Adnan; Egan, Catherine A.; Keane, Pearse A.

2016-01-01

Modern ophthalmic practice in the United Kingdom is faced by the challenges of an aging population, increasing prevalence of systemic pathologies with ophthalmic manifestations, and emergent treatments that are revolutionary but dependent on timely monitoring and diagnosis. This represents a huge strain not only on diagnostic services but also outpatient management and surveillance capacity. There is an urgent need for newer means of managing this surge in demand and the socioeconomic burden it places on the health care system. Concurrently, there have been exponential increases in computing power, expansions in the strength and ubiquity of communications technologies, and developments in imaging capabilities. Advances in imaging have been not only in terms of resolution, but also in terms of anatomical coverage, allowing new inferences to be made. In spite of this, image analysis techniques are still currently superseded by expert ophthalmologist interpretation. Teleophthalmology is therefore currently perfectly placed to face this urgent and immediate challenge of provision of optimal and expert care to remote and multiple patients over widespread geographical areas. This article reviews teleophthalmology programs currently deployed in the United Kingdom, focusing on diabetic eye care but also discussing glaucoma, emergency eye care, and other retinal diseases. We examined current programs and levels of evidence for their utility, and explored the relationships between screening, teleophthalmology, disease detection, and monitoring before discussing aspects of health economics pertinent to diabetic eye care. The use of teleophthalmology presents an immense opportunity to manage the steadily increasing demand for eye care, but challenges remain in the delivery of practical, viable, and clinically proven solutions. PMID:26830492

Explaining the Effectiveness of the Contrast Culture Method for Managing Interpersonal Interactions across Cultures

ERIC Educational Resources Information Center

Hiratsuka, Hiroyoshi; Suzuki, Hanako; Pusina, Alexis

2016-01-01

One of the current challenges in the field of intercultural education comes from the limited availability of training efficacy studies. The present study focused on explaining the effectiveness of the Contrast Culture Method (CCM) as an intercultural education method for managing interpersonal interactions across cultures between graduate…

Climate Project Screening Tool

Treesearch

Forest Service U.S. Department of Agriculture

2011-01-01

Climate change poses a challenge for resource managers as they review current management practices. Adaptation is a critical means of addressing climate change in the near future because, due to inherent time lags in climate impacts, the effects of increased atmospheric greenhouse gases will be felt for decades even if effective mitigation begins now. To address the...

Current Challenges in Higher Education Administration and Management

ERIC Educational Resources Information Center

Baldwin, Jon F.

2009-01-01

UK higher education has a proud tradition stretching back centuries, with St. Andrews almost 600 years old, and teaching having existed at Oxford for more than 900 years. There is no reason why universities established more recently should not demonstrate similar longevity. The management of stakeholders has always been central to the successful…

The New Management: Democracy and Enterprise Are Transforming Organizations.

ERIC Educational Resources Information Center

Halal, William E.

Some organizational theorists argue that current approaches to management are not going to work in the 21st century. The book explores this modern dilemma and presents two premises underlying the design of organizations capable of responding to an increasingly complex and challenging business and social environment. The first premise is that the…

Realigning the Values of Academic Health Centers: The Role of Innovative Faculty Management.

ERIC Educational Resources Information Center

Arana, George W.; McCurdy, Layton

1995-01-01

The current approach to research, teaching, clinical service, and administration at academic health centers is reviewed, and the traditional values underpinning this approach are challenged. A new form of faculty management that matches the individual faculty member's priorities and skills with the health center mission and which focuses on the…

Young People's and Parent's Perceptions of Managed Moves

ERIC Educational Resources Information Center

Bagley, Christopher; Hallam, Susan

2016-01-01

The current research aimed to increase understanding of the experiences of young people and their parents of managed moves, what contributed to success and the nature of the challenges experienced. The study was conducted in one English Local Authority, where five young people and their parents were interviewed. Five superordinate themes emerged…

Building Student Proficiency with Scientific Literature Using the Zotero Reference Manager Platform

ERIC Educational Resources Information Center

Kim, Thomas

2011-01-01

While mastery of the scientific literature is a strongly desirable trait for undergraduate students, the sheer volume of the current literature has complicated the challenge of teaching scientific literacy. Part of the response to this ever-increasing volume of resources includes formal instruction in the use of reference manager software while…

Integrated pest management of coffee berry borer in Hawaii and Puerto Rico: current status and prospects

USDA-ARS?s Scientific Manuscript database

The coffee berry borer (CBB), Hypothenemus hampei, is the most significant insect pest of coffee worldwide. Since CBB was detected in Puerto Rico in 2007 and Hawaii in 2010, coffee growers from these islands are facing increased costs, reduced coffee quality, and increased pest management challenges...

Challenges facing translational research organizations in China: a qualitative multiple case study

PubMed Central

2013-01-01

Background Translational medicine is attracting much attention worldwide and many translational research organizations (TROs) have been established. In China, translational medicine has developed rapidly, but faces many challenges. This study was aimed at exploring these challenges faced by emerging TROs in China. Method A qualitative, multiple case study approach was used to assess the challenges faced by TROs in China. Data were collected between May and August 2012. Results Eight cases were identified. Overall, four themes that characterized TROs in China emerged from analyses: 1. objectives, organizer, and funding resources, 2. participating partners and research teams, 3. management, and 4. achievements. All TROs had objectives related to translating basic discovery to clinic treatment and cultivating translational researchers. In terms of organizer and funding resources, 7 out of 8 TROs were launched only by universities and/or hospitals, and funded mostly through research grants. As for participating partners and multidisciplinary research teams, all but one of the TROs only involved biomedical research institutions who were interested in translational research, and characterized as clinical research centers; 7 out of 8 TROs involved only researchers from biomedicine and clinical disciplines and none involved disciplines related to education, ethnicity, and sociology, or engaged the community. Current management of the TROs were generally nested within the traditional research management paradigms, and failed to adapt to the tenets of translational research. Half of the TROs were at developmental stages defined as infrastructure construction and recruitment of translational researchers. Conclusions TROs in China face the challenge of attracting sustainable funding sources, widening multidisciplinary cooperation, cultivating multi-disciplinary translational researchers and adapting current research management to translational research. Greater emphasis should be placed on increasing multidisciplinary cooperation, and innovating in education programs to cultivate of translational researchers. Efforts should be made to reform research management in TROs, and establish sustainable funding resources. PMID:24119837

Application of Life Cycle Assessment on Electronic Waste Management: A Review.

PubMed

Xue, Mianqiang; Xu, Zhenming

2017-04-01

Electronic waste is a rich source of both valuable materials and toxic substances. Management of electronic waste is one of the biggest challenges of current worldwide concern. As an effective and prevailing environmental management tool, life cycle assessment can evaluate the environmental performance of electronic waste management activities. Quite a few scientific literatures reporting life cycle assessment of electronic waste management with significant outcomes have been recently published. This paper reviewed the trends, characteristics, research gaps, and challenges of these studies providing detailed information for practitioners involved in electronic waste management. The results showed that life cycle assessment studies were most carried out in Europe, followed by Asia and North America. The research subject of the studies mainly includes monitors, waste printed circuit boards, mobile phones, computers, printers, batteries, toys, dishwashers, and light-emitting diodes. CML was the most widely used life cycle impact assessment method in life cycle assessment studies on electronic waste management, followed by EI99. Furthermore, 40% of the reviewed studies combined with other environmental tools, including life cycle cost, material flow analysis, multi-criteria decision analysis, emergy analysis, and hazard assessment which came to more comprehensive conclusions from different aspects. The research gaps and challenges including uneven distribution of life cycle assessment studies, life cycle impact assessment methods selection, comparison of the results, and uncertainty of the life cycle assessment studies were examined. Although life cycle assessment of electronic waste management facing challenges, their results will play more and more important role in electronic waste management practices.

Application of Life Cycle Assessment on Electronic Waste Management: A Review

NASA Astrophysics Data System (ADS)

Xue, Mianqiang; Xu, Zhenming

2017-04-01

Electronic waste is a rich source of both valuable materials and toxic substances. Management of electronic waste is one of the biggest challenges of current worldwide concern. As an effective and prevailing environmental management tool, life cycle assessment can evaluate the environmental performance of electronic waste management activities. Quite a few scientific literatures reporting life cycle assessment of electronic waste management with significant outcomes have been recently published. This paper reviewed the trends, characteristics, research gaps, and challenges of these studies providing detailed information for practitioners involved in electronic waste management. The results showed that life cycle assessment studies were most carried out in Europe, followed by Asia and North America. The research subject of the studies mainly includes monitors, waste printed circuit boards, mobile phones, computers, printers, batteries, toys, dishwashers, and light-emitting diodes. CML was the most widely used life cycle impact assessment method in life cycle assessment studies on electronic waste management, followed by EI99. Furthermore, 40% of the reviewed studies combined with other environmental tools, including life cycle cost, material flow analysis, multi-criteria decision analysis, emergy analysis, and hazard assessment which came to more comprehensive conclusions from different aspects. The research gaps and challenges including uneven distribution of life cycle assessment studies, life cycle impact assessment methods selection, comparison of the results, and uncertainty of the life cycle assessment studies were examined. Although life cycle assessment of electronic waste management facing challenges, their results will play more and more important role in electronic waste management practices.

Urban ecosystem services for resilience planning and management in New York City.

PubMed

McPhearson, Timon; Hamstead, Zoé A; Kremer, Peleg

2014-05-01

We review the current state of knowledge about urban ecosystem services in New York City (NYC) and how these services are regulated, planned for, and managed. Focusing on ecosystem services that have presented challenges in NYC-including stormwater quality enhancement and flood control, drinking water quality, food provisioning and recreation-we find that mismatches between the scale of production and scale of management occur where service provision is insufficient. Adequate production of locally produced services and services which are more accessible when produced locally is challenging in the context of dense urban development that is characteristic of NYC. Management approaches are needed to address scale mismatches in the production and consumption of ecosystem services. By coordinating along multiple scales of management and promoting best management practices, urban leaders have an opportunity to ensure that nature and ecosystem processes are protected in cities to support the delivery of fundamental urban ecosystem services.

Women's infertility: challenges for practice.

PubMed

Carryer, J; Maclean, S

1998-03-01

Infertility is an issue for men and women but it is women who experience the majority of the diagnostic and treatment procedures. Nurses and midwives care for women in a variety of settings in which infertility is managed. This management is currently characterised by an escalation in related technologies and there is the potential for prolonged and complex endeavours to achieve a pregnancy. This paper reviews some pertinent literature from nursing, medicine, feminist scholars and the popular press to consider the ways in which infertility is understood and experienced. The challenge for nurses and midwives is in negotiating the differing perspectives in order to provide appropriate care to each individual woman as she experiences infertility and its management.

Meeting the challenge of interacting threats in freshwater ecosystems: A call to scientists and managers

USGS Publications Warehouse

Craig, Laura S.; Olden, Julian D.; Arthington, Angela; Entrekin, Sally; Hawkins, Charles P.; Kelly, John J.; Kennedy, Theodore A.; Maitland, Bryan M.; Rosi, Emma J.; Roy, Allison; Strayer, David L.; Tank, Jennifer L.; West, Amie O.; Wooten, Matthew S.

2017-01-01

Human activities create threats that have consequences for freshwater ecosystems and, in most watersheds, observed ecological responses are the result of complex interactions among multiple threats and their associated ecological alterations. Here we discuss the value of considering multiple threats in research and management, offer suggestions for filling knowledge gaps, and provide guidance for addressing the urgent management challenges posed by multiple threats in freshwater ecosystems. There is a growing literature assessing responses to multiple alterations, and we build off this background to identify three areas that require greater attention: linking observed alterations to threats, understanding when and where threats overlap, and choosing metrics that best quantify the effects of multiple threats. Advancing science in these areas will help us understand existing ecosystem conditions and predict future risk from multiple threats. Because addressing the complex issues and novel ecosystems that arise from the interaction of multiple threats in freshwater ecosystems represents a significant management challenge, and the risks of management failure include loss of biodiversity, ecological goods, and ecosystem services, we also identify actions that could improve decision-making and management outcomes. These actions include drawing insights from management of individual threats, using threat attributes (e.g., causes and spatio-temporal dynamics) to identify suitable management approaches, testing management strategies that are likely to be successful despite uncertainties about the nature of interactions among threats, avoiding unintended consequences, and maximizing conservation benefits. We also acknowledge the broadly applicable challenges of decision-making within a socio-political and economic framework, and suggest that multidisciplinary teams will be needed to innovate solutions to meet the current and future challenge of interacting threats in freshwater ecosystems. 

Biologically Based Methods for Pest Management in Agriculture under Changing Climates: Challenges and Future Directions.

PubMed

Chidawanyika, Frank; Mudavanhu, Pride; Nyamukondiwa, Casper

2012-11-09

The current changes in global climatic regimes present a significant societal challenge, affecting in all likelihood insect physiology, biochemistry, biogeography and population dynamics. With the increasing resistance of many insect pest species to chemical insecticides and an increasing organic food market, pest control strategies are slowly shifting towards more sustainable, ecologically sound and economically viable options. Biologically based pest management strategies present such opportunities through predation or parasitism of pests and plant direct or indirect defense mechanisms that can all be important components of sustainable integrated pest management programs. Inevitably, the efficacy of biological control systems is highly dependent on natural enemy-prey interactions, which will likely be modified by changing climates. Therefore, knowledge of how insect pests and their natural enemies respond to climate variation is of fundamental importance in understanding biological insect pest management under global climate change. Here, we discuss biological control, its challenges under climate change scenarios and how increased global temperatures will require adaptive management strategies to cope with changing status of insects and their natural enemies.

3D Printing Provides a Precise Approach in the Treatment of Tetralogy of Fallot, Pulmonary Atresia with Major Aortopulmonary Collateral Arteries.

PubMed

Anwar, Shafkat; Rockefeller, Toby; Raptis, Demetrios A; Woodard, Pamela K; Eghtesady, Pirooz

2018-02-03

Patients with tetralogy of Fallot, pulmonary atresia, and multiple aortopulmonary collateral arteries (Tet PA MAPCAs) have a wide spectrum of anatomy and disease severity. Management of these patients can be challenging and often require multiple high-risk surgical and interventional catheterization procedures. These interventions are made challenging by complex anatomy that require the proceduralist to mentally reconstruct three-dimensional anatomic relationships from two-dimensional images. Three-dimensional (3D) printing is an emerging medical technology that provides added benefits in the management of patients with Tet PA MAPCAs. When used in combination with current diagnostic modalities and procedures, 3D printing provides a precise approach to the management of these challenging, high-risk patients. Specifically, 3D printing enables detailed surgical and interventional planning prior to the procedure, which may improve procedural outcomes, decrease complications, and reduce procedure-related radiation dose and contrast load.

Wildfire and invasive species in the west: challenges that hinder current and furture management and protection of the sagebrush-steppe ecosystem

USDA-ARS?s Scientific Manuscript database

Western Association of Fish and Wildlife Agencies (WAFWA) to satisfy the 45-day report requirement identified in Cooperative Agreement (F13AC00353) between WAFWA and the U. S. Fish and Wildlife Service (FWS) submit this “Gap Report”. This report summarizes the policy, fiscal and science challenges t...

Congestion Management Systems: Review of Current Practices.

DOT National Transportation Integrated Search

2004-10-31

National parks roads and parkways integrate highway engineering and landscape architecture in their designs to provide access to recreational areas, and to provide scenic recreational travel opportunities. Typically the engineering challenge is to bu...

Rare cancers: Challenges & issues.

PubMed

Pillai, Raveendran K; Jayasree, K

2017-01-01

Rare cancers account for about 22 per cent of all cancers diagnosed worldwide, disproportionately affecting some demographic groups, with an occurrence of less than 6 per 100,000 individuals annually. Many rare cancers in adults, adolescents and children are not curable, and patients and care providers have little option to take therapeutic decisions. The epidemiology of rare cancers is a challenging area of study but is inadequately addressed. Despite efforts mainly in some European nations, a few improvements have been observed in the management of rare cancers. Reasons for this obvious stagnation are multifactorial and are mainly inherent to logistical difficulties in carrying out clinical trials in very small patient populations, hesitation of the pharmaceutical industry to spend in small markets and complexity in creating adequate information for the development of cost-effective drugs. Rare cancers also face specific challenges that include late and incorrect diagnosis, lack of clinical expertise and lack of research interest and development of new therapies. The utilization of nationally representative study findings for the patients' evaluation may possibly offer chances to find out pathogenesis and prevalence, and this will eventually lead to control and prevention. Currently, advancing targeted therapies offer a great opportunity for the better management of rare cancers. Conducting clinical trials with small patient population, innovative clinical trial approach, prevailing controlling obstacles for international cooperation and financial support for research are the present challenges for rare cancers. The International Rare Cancers Initiative functions as a main platform for achieving new international clinical trials in rare tumours. This review delineates the current challenges and issues in the interpretation, management and research scenarios of rare cancers.

Rare cancers: Challenges & issues

PubMed Central

Pillai, Raveendran K.; Jayasree, K.

2017-01-01

Rare cancers account for about 22 per cent of all cancers diagnosed worldwide, disproportionately affecting some demographic groups, with an occurrence of less than 6 per 100,000 individuals annually. Many rare cancers in adults, adolescents and children are not curable, and patients and care providers have little option to take therapeutic decisions. The epidemiology of rare cancers is a challenging area of study but is inadequately addressed. Despite efforts mainly in some European nations, a few improvements have been observed in the management of rare cancers. Reasons for this obvious stagnation are multifactorial and are mainly inherent to logistical difficulties in carrying out clinical trials in very small patient populations, hesitation of the pharmaceutical industry to spend in small markets and complexity in creating adequate information for the development of cost-effective drugs. Rare cancers also face specific challenges that include late and incorrect diagnosis, lack of clinical expertise and lack of research interest and development of new therapies. The utilization of nationally representative study findings for the patients’ evaluation may possibly offer chances to find out pathogenesis and prevalence, and this will eventually lead to control and prevention. Currently, advancing targeted therapies offer a great opportunity for the better management of rare cancers. Conducting clinical trials with small patient population, innovative clinical trial approach, prevailing controlling obstacles for international cooperation and financial support for research are the present challenges for rare cancers. The International Rare Cancers Initiative functions as a main platform for achieving new international clinical trials in rare tumours. This review delineates the current challenges and issues in the interpretation, management and research scenarios of rare cancers. PMID:28574010

Integrating Academic Management with Business Planning Activities: The Case of University of Education, Winneba (UEW), Ghana

ERIC Educational Resources Information Center

Owusu-Ansah, Collins; Afful, Deborah

2015-01-01

Currently, public universities are facing chronic problem of underfunding. In a bid to explore more alternative and innovative ways of addressing such underfunding challenges, authorities of universities have sought to inject business activities into the management of the universities. They are now forced to search for additional sources of income…

Biodiversity informatics: challenges and opportunities for applying biodiversity information to management and conservation

Treesearch

James S. Kagan

2006-01-01

Researchers, land managers, and the public currently often are unable to obtain useful biodiversity information because the subject represents such a large component of biology and ecology, and systems to compile and organize this information do not exist. Information on vascular plant taxonomy, as addressed by the Global Biodiversity Information Facility and key...

Foundational literature for moving native plant materials in changing climates

Treesearch

Mary I. Williams; Kas Dumroese; Jeremy Pinto; Martin F. Jurgensen

2015-01-01

Seed transfer guidelines and zones are used to manage the movement of plant materials, but by the end of the century many landscapes across the globe will have climates that are incompatible with current vegetation. The mismatch in rates between climate change and plant migration and adaptation will pose significant challenges for natural resource managers, especially...

Addressing Bullying Problems in Irish Schools and in Cyberspace: A Challenge for School Management

ERIC Educational Resources Information Center

Corcoran, Lucie; Mc Guckin, Conor

2014-01-01

Background: School management, in Ireland and also internationally, are currently faced with the problem of peer aggression among students both in a traditional school context and in a cyber context. Although Irish school principals are obliged to implement policy and procedures to counter bullying among students, there is a need for guidance that…

Disorders of Excessive Daytime Sleepiness Including Narcolepsy and Idiopathic Hypersomnia.

PubMed

Berkowski, Joseph Andrew; Shelgikar, Anita Valanju

2016-09-01

Central disorders of hypersomnolence are rare conditions with a poorly understood pathophysiology, making the identification and management challenging for sleep clinicians. Clinical history is essential for ruling out secondary causes of hypersomnolence and distinguishing among diagnoses. Current diagnostic criteria rely heavily on the polysomnogram and multiple sleep latency test. The current focus of treatment of hypersomnolence is on drugs that promote alertness. Additionally, in the case of narcolepsy type 1, medication management addresses control of cataplexy, the hallmark symptom of this disorder. Elucidation of pathophysiology of these disorders in the future will be essential to better categorization and management. Published by Elsevier Inc.

Evaluation and Management Strategies for Per- and Polyfluoroalkyl Substances (PFASs) in Drinking Water Aquifers: Perspectives from Impacted U.S. Northeast Communities.

PubMed

Guelfo, Jennifer L; Marlow, Thomas; Klein, David M; Savitz, David A; Frickel, Scott; Crimi, Michelle; Suuberg, Eric M

2018-06-01

Multiple Northeast U.S. communities have discovered per- and polyfluoroalkyl substances (PFASs) in drinking water aquifers in excess of health-based regulatory levels or advisories. Regional stakeholders (consultants, regulators, and others) need technical background and tools to mitigate risks associated with exposure to PFAS-affected groundwater. The aim was to identify challenges faced by stakeholders to extend best practices to other regions experiencing PFAS releases and to establish a framework for research strategies and best management practices. Management challenges were identified during stakeholder engagement events connecting attendees with PFAS experts in focus areas, including fate/transport, toxicology, and regulation. Review of the literature provided perspective on challenges in all focus areas. Publicly available data were used to characterize sources of PFAS impacts in groundwater and conduct a geospatial case study of potential source locations relative to drinking water aquifers in Rhode Island. Challenges in managing PFAS impacts in drinking water arise from the large number of relevant PFASs, unconsolidated information regarding sources, and limited studies on some PFASs. In particular, there is still considerable uncertainty regarding human health impacts of PFASs. Frameworks sequentially evaluating exposure, persistence, and treatability can prioritize PFASs for evaluation of potential human health impacts. A regional case study illustrates how risk-based, geospatial methods can help address knowledge gaps regarding potential sources of PFASs in drinking water aquifers and evaluate risk of exposure. Lessons learned from stakeholder engagement can assist in developing strategies for management of PFASs in other regions. However, current management practices primarily target a subset of PFASs for which in-depth studies are available. Exposure to less-studied, co-occurring PFASs remains largely unaddressed. Frameworks leveraging the current state of science can be applied toward accelerating this process and reducing exposure to total PFASs in drinking water, even as research regarding health effects continues. https://doi.org/10.1289/EHP2727.

The U.S. Forest Service's analysis of cumulative effects to wildlife: A study of legal standards, current practice, and ongoing challenges on a National Forest

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schultz, Courtney A., E-mail: courtney.schultz@colostate.edu

Cumulative effects analysis (CEA) allows natural resource managers to understand the status of resources in historical context, learn from past management actions, and adapt future activities accordingly. U.S. federal agencies are required to complete CEA as part of environmental impact assessment under the National Environmental Policy Act (NEPA). Past research on CEA as part of NEPA has identified significant deficiencies in CEA practice, suggested methodologies for handling difficult aspects of CEA, and analyzed the rise in litigation over CEA in U.S. courts. This article provides a review of the literature and legal standards related to CEA as it is donemore » under NEPA and then examines current practice on a U.S. National Forest, utilizing qualitative methods in order to provide a detailed understanding of current approaches to CEA. Research objectives were to understand current practice, investigate ongoing challenges, and identify impediments to improvement. Methods included a systematic review of a set of NEPA documents and semi-structured interviews with practitioners, scientists, and members of the public. Findings indicate that the primary challenges associated with CEA include: issues of both geographic and temporal scale of analysis, confusion over the purpose of the requirement, the lack of monitoring data, and problems coordinating and disseminating data. Improved monitoring strategies and programmatic analyses could support improved CEA practice.« less

Understanding Challenges, Strategies, and the Role of Support Networks in Medication Self-management Among Patients With Type 2 Diabetes.

PubMed

Bernhard, Gerda; Ose, Dominik; Baudendistel, Ines; Seidling, Hanna M; Stützle, Marion; Szecsenyi, Joachim; Wensing, Michel; Mahler, Cornelia

2017-04-01

Purpose The purpose of this qualitative study was to investigate the challenges and strategies of patients with type 2 diabetes mellitus (T2DM) regarding daily management of their medication regimen focusing on the role of their support networks. Methods A purposeful sample of 25 patients with T2DM was recruited from local self-help groups, general practitioner practices, and a university hospital in southwestern Germany. Four semi-structured focus groups were conducted to identify the challenges patients experienced, the strategies they used, and their collaboration with support networks to assist them in self-managing their medication regimen. Sessions were audio- and video-recorded, fully transcribed, and subjected to computer-aided qualitative content analysis, guided by the Self- and Family Management Framework (SFMF). Results Patients with T2DM experienced numerous challenges affecting medication self-management arising from their personal situation, health status and resources, characteristics of their regimen, and how health care is currently organized. Patients' self-initiated strategies included activating health care, community, social, and online resources; taking ownership of medication-related needs; and integrating medication-taking into daily life. Patients drew on self-help groups, family, and friends to discuss concerns regarding medication safety and receive experience-based information and advice for navigating within the health care system as well as practical hands-on support with daily medication self-management. Conclusions Understanding the challenges and building on strategies patients with T2DM devised help diabetes educators to better address patients' needs and priorities and guide patient-centered interventions to support patients' self-management activities. Community and social support networks operating in patients' lives need to be engaged in the self-management support.

Desalination and reuse of high-salinity shale gas produced water: drivers, technologies, and future directions.

PubMed

Shaffer, Devin L; Arias Chavez, Laura H; Ben-Sasson, Moshe; Romero-Vargas Castrillón, Santiago; Yip, Ngai Yin; Elimelech, Menachem

2013-09-03

In the rapidly developing shale gas industry, managing produced water is a major challenge for maintaining the profitability of shale gas extraction while protecting public health and the environment. We review the current state of practice for produced water management across the United States and discuss the interrelated regulatory, infrastructure, and economic drivers for produced water reuse. Within this framework, we examine the Marcellus shale play, a region in the eastern United States where produced water is currently reused without desalination. In the Marcellus region, and in other shale plays worldwide with similar constraints, contraction of current reuse opportunities within the shale gas industry and growing restrictions on produced water disposal will provide strong incentives for produced water desalination for reuse outside the industry. The most challenging scenarios for the selection of desalination for reuse over other management strategies will be those involving high-salinity produced water, which must be desalinated with thermal separation processes. We explore desalination technologies for treatment of high-salinity shale gas produced water, and we critically review mechanical vapor compression (MVC), membrane distillation (MD), and forward osmosis (FO) as the technologies best suited for desalination of high-salinity produced water for reuse outside the shale gas industry. The advantages and challenges of applying MVC, MD, and FO technologies to produced water desalination are discussed, and directions for future research and development are identified. We find that desalination for reuse of produced water is technically feasible and can be economically relevant. However, because produced water management is primarily an economic decision, expanding desalination for reuse is dependent on process and material improvements to reduce capital and operating costs.

Diagnosis and management of malignant pleural effusions: state of the art in 2017

PubMed Central

Lee, Hans J.

2017-01-01

Malignant pleural effusion (MPE) is a known complication of both thoracic and extra thoracic malignancies. The presence of MPE regardless of the primary site translates into advanced stage disease. Diagnosis and management of MPE with the goals of palliation and improving quality of life poses a challenge for chest physicians. Recently, multiple studies have made attempts to answer questions regarding optimal management in various clinical scenarios. We will review the current evidence and available options for the management of MPE. PMID:29214068

Management of Leigh syndrome: Current status and new insights.

PubMed

Chen, L; Cui, Y; Jiang, D; Ma, C Y; Tse, H-F; Hwu, W-L; Lian, Q

2018-06-01

Leigh syndrome (LS) is an inherited mitochondrial encephalopathy associated with gene mutations of oxidative phosphorylation pathway that result in early disability and death in affected young children. Currently, LS is incurable and unresponsive to many treatments, although some case reports indicate that supplements can improve the condition. Many novel therapies are being continuously tested in pre-clinical studies. In this review, we summarize the genetic basis of LS, current treatment, pre-clinical studies in animal models and the management of other mitochondrial diseases. Future therapeutical strategies and challenges are also discussed. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Disease management: old wine in new bottles?

PubMed

Ritterband, D R

2000-01-01

Disease management is a holistic, patient-focused approach to the treatment of disease across the spectrum of healthcare delivery. In its current form, disease management was created in response to the societal and economic burden that chronic illness contributes. There has recently been rapid growth in the development of disease management programs and sponsors are widespread within the industry, with the largest increase in independent vendors. Although growth has been substantial, the hurdles these programs have encountered have kept them from reaching their full potential. The challenges that exist include clinical, financial, and regulatory issues, and these challenges have significant meaning to healthcare managers. In deciding whether to develop or enhance programs, executives must consider their capability of outcomes measurement, their provider relationships, and the arrangements for program implementation. Ultimately, if programs provide improved health and quality of life for participants, cost savings will follow.

Atherosclerotic renovascular disease – epidemiology, treatment and current challenges

PubMed Central

Vassallo, Diana

2017-01-01

The neutral results of recent large randomized controlled trials comparing renal revascularization with optimal medical therapy in patients with atherosclerotic renovascular disease (ARVD) have cast doubt on the role of revascularization in the management of unselected patients with this condition. However, these studies have strengthened the evidence base for the role of contemporary intensive medical vascular protection therapy and aggressive risk factor control in improving clinical outcomes in ARVD. Patients presenting with ‘high-risk’ clinical features such as uncontrolled hypertension, rapidly declining renal function or flash pulmonary oedema are underrepresented in these studies; hence these results may not be applicable to all patients with ARVD. In this ‘high-risk’ subgroup, conservative management may not be sufficient in preventing adverse events, and indeed, observational evidence suggests that this specific patient subgroup may gain benefit from timely renal revascularization. Current challenges include the development of novel diagnostic techniques to establish haemodynamic significance of a stenosis, patient risk stratification and prediction of post-revascularization outcomes to ultimately facilitate patient selection for revascularization. In this paper we describe the epidemiology of this condition and discuss treatment recommendations for this condition in light of the results of recent randomized controlled trials while highlighting important clinical unmet needs and challenges faced by clinicians managing this condition. PMID:29056991

Management of Nasopharyngeal Carcinoma: Current Practice and Future Perspective.

PubMed

Lee, Anne W M; Ma, Brigette B Y; Ng, Wai Tong; Chan, Anthony T C

2015-10-10

Nasopharyngeal carcinoma of the undifferentiated subtype is endemic to southern China, and patient prognosis has improved significantly over the past three decades because of advances in disease management, diagnostic imaging, radiotherapy technology, and broader application of systemic therapy. Despite the excellent local control with modern radiotherapy, distant failure remains a key challenge. Advances in molecular technology have helped to decipher the molecular pathogenesis of nasopharyngeal carcinoma as well as its etiologic association with the Epstein-Barr virus. This in turn has led to the discovery of novel biomarkers and drug targets, rendering this cancer site a current focus for new drug development. This article reviews and appraises the key literature on the current management of nasopharyngeal carcinoma and future directions in clinical research. © 2015 by American Society of Clinical Oncology.

Improving Forecasts for Water Management

NASA Astrophysics Data System (ADS)

Arumugam, Sankar; Wood, Andy; Rajagopalan, Balaji; Schaake, John

2014-01-01

Recent advances in seasonal to interannual hydroclimate predictions provide an opportunity for developing a proactive approach toward water management. This motivated a recent AGU Chapman Conference (see program details at http://chapman.agu.org/watermanagement/). Approximately 85 participants from the United States, Oceania, Asia, Europe, and South America presented and discussed the current state of successes, challenges, and opportunities in seasonal to interannual hydroclimate forecasts and water management, and a number of key messages emerged.

Managing Asthma in Low-Income, Underrepresented Minority, and Other Disadvantaged Pediatric Populations: Closing the Gap.

PubMed

Louisias, Margee; Phipatanakul, Wanda

2017-09-15

In this article, we review current understanding of the epidemiology and etiology of disparities in asthma. We also highlight current and emerging literature on solutions to tackle disparities while underscoring gaps and pressing future directions. Tailored, multicomponent approaches including the home, school, and clinician-based interventions show great promise. Managing asthma in disadvantaged populations can be challenging as they tend to have disproportionately worse outcomes due to a multitude of factors. However, multifaceted, innovative interventions that are sustainable and scalable are key to improving outcomes.

Current and Emerging Therapies for the Management of Functional Gastrointestinal Disorders

PubMed Central

Craig, Orla F.; Quigley, Eamonn M. M.

2011-01-01

The functional gastrointestinal disorders are common disorders that are associated with significant quality-of-life impairment and considerable economic burden on the healthcare system. They are frequently associated with a comorbid psychiatric condition; this, together with a striking lack of effective pharmacological therapies, means they represent a considerable therapeutic challenge to the treating physician. In this overview, we examine the evidence to support the use of agents currently used in the management of the more common functional gastrointestinal disorders and review emerging therapies. PMID:23251744

Splenic injuries in athletes: a review.

PubMed

Gannon, Elizabeth H; Howard, Thomas

2010-01-01

Splenic injuries can be challenging to the sports medicine physician. While these injuries are not common among athletes, they can have serious, potentially fatal consequences if not properly diagnosed and managed in a prompt and timely fashion. Currently, there are no evidence-based guidelines on returning athletes to previous levels of activity after sustaining a splenic injury. In addition, there is no consensus on follow-up imaging after injury. This article discusses the evaluation of athletes with blunt abdominal trauma for splenic injury, including the imaging, management, and current return-to-play guidelines.

ACTDs: Management Plans as Predictors of Transition

DTIC Science & Technology

2007-12-01

phase. Figure 2 shows the current ACTD funding model in place today and highlights the challenges involved in the process. Current ACTD Funding ... Model All other Sources (~70%) OSD AS&C Cash Resources (~30%) Army PE x PE x PE x PE x Navy PE x PE x PE x PE x USAF PE x PE x

Understanding Supply Chain Management Practices for Small and Medium-Sized Enterprises

NASA Astrophysics Data System (ADS)

Thoo, AC; Sulaiman, Z.; Choi, SL; Kohar, UHA

2017-06-01

Small and medium enterprises (SMEs) are a major source of dynamism, innovation and flexibility for emerging and developing countries, as well as for the economies of the most industrialised nations. However, the survival and growth of SMEs can be difficult in the current competitive business environment and global marketplace. It can be a real challenge to deliver the right product and service at the most opportune time and at the lowest possible cost to the right customer. The challenge stresses the importance of managing cross-boundary relationships between business partners. For gaining a competitive advantage, supply chain management (SCM) is an effective tool to SMEs. Therefore, this paper aims to review the tenet of SCM, its benefits and practices to SMEs.

Challenges in Clinical Management of Radiation-Induced Illnesses in Exploration Spaceflight

NASA Technical Reports Server (NTRS)

Blue, Rebecca; Chancellor, Jeffery; Suresh, Rahul; Carnell, Lisa; Reyes, David; Nowadly, Craig; Antonsen, Erik

2018-01-01

Historical solar particle events (SPEs) provide context for some understanding of acute radiation exposure risk to astronauts traveling outside of low Earth orbit. Modeling of potential doses delivered to exploration crewmembers anticipates limited radiation-induced health impacts, including prodromal symptoms of nausea, emesis, and fatigue, but suggests that more severe clinical manifestations are unlikely. Recent large animal-model research in space-analogs closely mimicking SPEs has identified coagulopathic events independent of the hematopoietic sequelae of higher radiation doses, similar in manifestation to disseminated intravascular coagulation (DIC). We explored the challenges of clinical management of radiation-related clinical manifestations, using currently accepted modeling techniques and anticipated physiological sequelae, to identify medical capabilities needed to successfully manage SPE-induced radiation illnesses during exploration spaceflight.

Improving our legacy: Incorporation of adaptive management into state wildlife action plans

USGS Publications Warehouse

Fontaine, J.J.

2011-01-01

The loss of biodiversity is a mounting concern, but despite numerous attempts there are few large scale conservation efforts that have proven successful in reversing current declines. Given the challenge of biodiversity conservation, there is a need to develop strategic conservation plans that address species declines even with the inherent uncertainty in managing multiple species in complex environments. In 2002, the State Wildlife Grant program was initiated to fulfill this need, and while not explicitly outlined by Congress follows the fundamental premise of adaptive management, 'Learning by doing'. When action is necessary, but basic biological information and an understanding of appropriate management strategies are lacking, adaptive management enables managers to be proactive in spite of uncertainty. However, regardless of the strengths of adaptive management, the development of an effective adaptive management framework is challenging. In a review of 53 State Wildlife Action Plans, I found a keen awareness by planners that adaptive management was an effective method for addressing biodiversity conservation, but the development and incorporation of explicit adaptive management approaches within each plan remained elusive. Only ???25% of the plans included a framework for how adaptive management would be implemented at the project level within their state. There was, however, considerable support across plans for further development and implementation of adaptive management. By furthering the incorporation of adaptive management principles in conservation plans and explicitly outlining the decision making process, states will be poised to meet the pending challenges to biodiversity conservation. ?? 2010 .

Improving our legacy: incorporation of adaptive management into state wildlife action plans.

PubMed

Fontaine, Joseph J

2011-05-01

The loss of biodiversity is a mounting concern, but despite numerous attempts there are few large scale conservation efforts that have proven successful in reversing current declines. Given the challenge of biodiversity conservation, there is a need to develop strategic conservation plans that address species declines even with the inherent uncertainty in managing multiple species in complex environments. In 2002, the State Wildlife Grant program was initiated to fulfill this need, and while not explicitly outlined by Congress follows the fundamental premise of adaptive management, 'Learning by doing'. When action is necessary, but basic biological information and an understanding of appropriate management strategies are lacking, adaptive management enables managers to be proactive in spite of uncertainty. However, regardless of the strengths of adaptive management, the development of an effective adaptive management framework is challenging. In a review of 53 State Wildlife Action Plans, I found a keen awareness by planners that adaptive management was an effective method for addressing biodiversity conservation, but the development and incorporation of explicit adaptive management approaches within each plan remained elusive. Only ~25% of the plans included a framework for how adaptive management would be implemented at the project level within their state. There was, however, considerable support across plans for further development and implementation of adaptive management. By furthering the incorporation of adaptive management principles in conservation plans and explicitly outlining the decision making process, states will be poised to meet the pending challenges to biodiversity conservation. Published by Elsevier Ltd.

Better management of multimorbidity: a critical look at the 'Ariadne principles'.

PubMed

Bower, Peter

2014-12-08

Primary care clinicians and researchers are growing increasingly aware of the prevalence of multimorbidity among long-term conditions, and the impact on patient experience, health, and utilisation of care. The correspondence paper by Muth et al. entitled 'The Ariadne principles: how to handle multimorbidity in primary care consultations' outlines new thinking on a better way to manage the challenges of decision-making in multimorbidity. The paper highlights the importance of shared treatment goals as a fundamental basis for more effective management. Although a welcome contribution to the literature, the principles raise a number of challenges: the complexities of achieving effective patient-centred assessment and goal-setting; how best to encourage implementation of new practices; and the current state of the evidence around multimorbidity and its management.Please see related article: http://www.biomedcentral.com/1741-7015/12/223.

"In the same boat": considerations on the partnership between healthcare providers and manufacturers of health IT products and medical devices.

PubMed

Bergh, B

2009-01-01

To assess the current culture of cooperation between healthcare providers (HCPs) and the healthcare industry (HCI) in the domain of Health-IT and Engineering (HITE) and identify possible strategies for improvement. Based on reports in the literature and personal experience, major challenges were identified, the current ways of cooperation defined and their relation to each other analyzed. Four main challenges were identified for both sides involving: products and functionality, integration of IT-Systems with each other and with medical devices, usability, visions and strategic management. None of the four defined cooperation categories cover all aspects of the challenges, but cooperation in small, dedicated groups appeared to provide the most advantages. An increased participation of HCPs in standardization activities is crucial either directly or indirectly via professional or scientific organizations. Cooperation between provider management (hospitals, clinics or systems) and manufacturers of health IT products will be the key factor for success of the HCI while providing substantial benefits for providers. Both sides should invest heavily in such efforts.

Tsunami Risk Management in Pacific Island Countries and Territories (PICTs): Some Issues, Challenges and Ways Forward

NASA Astrophysics Data System (ADS)

Dominey-Howes, Dale; Goff, James

2013-09-01

The Pacific is well known for producing tsunamis, and events such as the 2011 Tōhoku-oki, Japan disaster demonstrate the vulnerability of coastal communities. We review what is known about the current state of tsunami risk management for Pacific Island countries and territories (PICTs), identify the issues and challenges associated with affecting meaningful tsunami disaster risk reduction (DRR) efforts and outline strategies and possible ways forward. Small island states are scattered across the vast Pacific region and these states have to varying degrees been affected by not only large tsunamis originating in circum-Pacific subduction zones, but also more regionally devastating events. Having outlined and described what is meant by the risk management process, the various problems associated with our current understanding of this process are examined. The poorly understood hazard related to local, regional and distant sources is investigated and the dominant focus on seismic events at the expense of other tsunami source types is noted. We reflect on the challenges of undertaking numerical modelling from generation to inundation and specifically detail the problems as they relate to PICTs. This is followed by an exploration of the challenges associated with mapping exposure and estimating vulnerability in low-lying coastal areas. The latter part of the paper is devoted to exploring what mitigation of the tsunami risk can look like and draw upon good practice cases as exemplars of the actions that can be taken from the local to regional level. Importantly, given the diversity of PICTs, no one approach will suit all places. The paper closes by making a series of recommendations to assist PICTs and the wider tsunami research community in thinking through improvements to their tsunami risk management processes and the research that can underpin these efforts.

Using a GIS-based spot growth model and visual simulator to evaluate the effects of silvicultural treatments on southern pine beetle-infested stands

Treesearch

Chiao-Ying Chou; Roy L. Hedden; Bo Song; Thomas M. Williams

2013-01-01

Many models are available for simulating the probability of southern pine beetle (Dendroctonus frontalis Zimmermann) (SPB) infestation and outbreak dynamics. However, only a few models focused on the potential spatial SPB growth. Although the integrated pest management systems are currently adopted, SPB management is still challenging because of...

Putting the "Team" in the Fine Arts Team: An Application of Business Management Team Concepts

ERIC Educational Resources Information Center

Fisher, Ryan

2007-01-01

In this article, the author discusses current challenges to the idea of teamwork in fine arts teams, redefines the terms team and collaboration using a business management perspective, discusses the success of effective teams in the business world and the characteristics of those teams, and proposes the implementation of the business model of…

Evaluating carbon storage, timber harvest, and habitat possibilities for a Western Cascades (USA) forest landscape

Treesearch

Jeff Kline; Mark E. Harmon; Thomas A. Spies; Anita T. Morzillo; Robert J. Pabst; Brenda C. McComb; Frank Schnekenburger; Keith A. Olsen; Blair Csuti; Jody C. Vogeler

2016-01-01

Forest policymakers and managers have long sought ways to evaluate the capability of forest landscapes to jointly produce timber, habitat, and other ecosystem services in response to forest management. Currently, carbon is of particular interest as policies for increasing carbon storage on federal lands are being proposed. However, a challenge in joint production...

Primary osseous tumors of the pediatric spinal column: review of pathology and surgical decision making.

PubMed

Ravindra, Vijay M; Eli, Ilyas M; Schmidt, Meic H; Brockmeyer, Douglas L

2016-08-01

Spinal column tumors are rare in children and young adults, accounting for only 1% of all spine and spinal cord tumors combined. They often present diagnostic and therapeutic challenges. In this article, the authors review the current management of primary osseous tumors of the pediatric spinal column and highlight diagnosis, management, and surgical decision making.

A Survey of the Current Situation of Clinical Biobanks in China.

PubMed

Li, Haiyan; Ni, Mingyu; Wang, Peng; Wang, Xiaomin

2017-06-01

The development of biomedical research urgently needs the support of a large number of high-quality clinical biospecimens. Therefore, human biobanks at different levels have been established successively in China and other countries at a significantly increasing pace in recent years. To better understand the general current state of clinical biobanks in China, we surveyed 42 clinical biobanks based in hospitals and collected information involving their management systems, sharing mechanisms, quality control systems, and informational management systems using closed questionnaire methods. Based on our current information, there has not been such a large-scale survey in China. An understanding of the status and challenges current clinical biobanks face will provide valuable insights for the construction and sustainable development of higher quality clinical biobanks.

Technology in School Foodservice Operations.

ERIC Educational Resources Information Center

Callahan, Tom; Sharma, Vijay K.

2002-01-01

Describes the current state of technology to manage school food-service operations, including, for example, the use of automation to identify and feed needy students and the use of the Internet. Describes challenges of implementing an automated system. (PKP)

Hazardous and toxic waste management in Botswana: practices and challenges.

PubMed

Mmereki, Daniel; Li, Baizhan; Meng, Liu

2014-12-01

Hazardous and toxic waste is a complex waste category because of its inherent chemical and physical characteristics. It demands for environmentally sound technologies and know-how as well as clean technologies that simultaneously manage and dispose it in an environmentally friendly way. Nevertheless, Botswana lacks a system covering all the critical steps from importation to final disposal or processing of hazardous and toxic waste owing to limited follow-up of the sources and types of hazardous and toxic waste, lack of modern and specialised treatment/disposal facilities, technical know-how, technically skilled manpower, funds and capabilities of local institutions to take lead in waste management. Therefore, because of a lack of an integrated system, there are challenges such as lack of cooperation among all the stakeholders about the safe management of hazardous and toxic waste. Furthermore, Botswana does not have a systematic regulatory framework regarding monitoring and hazardous and toxic waste management. In addition to the absence of a systematic regulatory framework, inadequate public awareness and dissemination of information about hazardous and toxic waste management, slower progress to phase-out persistent and bio-accumulative waste, and lack of reliable and accurate information on hazardous and toxic waste generation, sources and composition have caused critical challenges to effective hazardous and toxic waste management. It is, therefore, important to examine the status of hazardous and toxic waste as a waste stream in Botswana. By default; this mini-review article presents an overview of the current status of hazardous and toxic waste management and introduces the main challenges in hazardous and toxic waste management. Moreover, the article proposes the best applicable strategies to achieve effective hazardous and toxic waste management in the future. © The Author(s) 2014.

How do older people with sight loss manage their general health? A qualitative study.

PubMed

Burton, Amy E; Gibson, Jonathan M; Shaw, Rachel L

2016-11-01

Older people with sight loss experience a number of barriers to managing their health. The purpose of this qualitative study was to explore how older people with sight loss manage their general health and explore the techniques used and strategies employed for health management. Semi-structured face-to-face interviews were conducted with 30 participants. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Health management challenges experienced included: managing multiple health conditions; accessing information; engaging in health behaviours and maintaining wellbeing. Positive strategies included: joining support groups, clubs and societies; using low vision aids; seeking support from family and friends and accessing support through health and social care services. Healthcare professionals need to be more aware of the challenges faced by older people with sight loss. Improved promotion of group support and charity services which are best placed to share information, provide fora to learn about coping techniques and strategies, and give older people social support to prevent isolation is needed. Rehabilitation and support services and equipment can only be beneficial if patients know what is available and how to access them. Over-reliance on self-advocacy in current healthcare systems is not conducive to patient-centred care. Implications for Rehabilitation Sight loss in older people can impact on many factors including health management. This study identifies challenges to health management and highlights strategies used by older people with sight loss to manage their health. Access to support often relies on patients seeking information for themselves. However, self-advocacy is challenging due to information accessibility barriers. Informal groups and charities play an important role in educating patients about their condition and advising on available support to facilitate health management.

Providers' Perspectives on Case Management of a Healthy Start Program: A Qualitative Study

PubMed Central

Moise, Imelda K.; Mulhall, Peter F.

2016-01-01

Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking clients to adequate services rather than reporting performance. Case managers favored measurable deliverables rather than operational work products. A proposed solution to current challenges emphasizes and encourages the iterative learning process and shared decision making between program targets, funders and providers. Case managers are aware of the challenging environment in which they operate for their clients and for themselves. However, future interventions will require clearly identified performance measures and increased systems support. PMID:27149061

Translational Science Project Team Managers: Qualitative Insights and Implications from Current and Previous Postdoctoral Experiences.

PubMed

Wooten, Kevin C; Dann, Sara M; Finnerty, Celeste C; Kotarba, Joseph A

2014-07-01

The development of leadership and project management skills is increasingly important to the evolution of translational science and team-based endeavors. Team science is dependent upon individuals at various stages in their careers, inclusive of postdocs. Data from case histories, as well as from interviews with current and former postdocs, and those supervising postdocs, indicate six essential tasks required of project managers in multidisciplinary translational teams, along with eight skill-related themes critical to their success. To optimize the opportunities available and to ensure sequential development of team project management skills, a life cycle model for the development of translational team skills is proposed, ranging from graduate trainees, postdocs, assistant professors, and finally to mature scientists. Specific goals, challenges and project management roles and tasks are recommended for each stage for the life cycle.

Translational Science Project Team Managers: Qualitative Insights and Implications from Current and Previous Postdoctoral Experiences

PubMed Central

Wooten, Kevin C.; Dann, Sara M.; Finnerty, Celeste C.; Kotarba, Joseph A.

2015-01-01

The development of leadership and project management skills is increasingly important to the evolution of translational science and team-based endeavors. Team science is dependent upon individuals at various stages in their careers, inclusive of postdocs. Data from case histories, as well as from interviews with current and former postdocs, and those supervising postdocs, indicate six essential tasks required of project managers in multidisciplinary translational teams, along with eight skill-related themes critical to their success. To optimize the opportunities available and to ensure sequential development of team project management skills, a life cycle model for the development of translational team skills is proposed, ranging from graduate trainees, postdocs, assistant professors, and finally to mature scientists. Specific goals, challenges and project management roles and tasks are recommended for each stage for the life cycle. PMID:25621288

The current management of carotid atherosclerotic disease: who, when and how?

PubMed Central

Ritter, Jens C.; Tyrrell, Mark R.

2013-01-01

Ischaemic stroke represents a major health hazard in the western world, which has a severe impact on society and the health-care system. Roughly, 10% of all first ischaemic strokes can be attributed to significant atherosclerotic disease of the carotid arteries. Correct management of these lesions is essential in the prevention and treatment of carotid disease-related ischaemic events. The close relationship between diagnosis and medical and surgical management makes it necessary that all involved physicians and surgeons have profound knowledge of management strategies beyond their specific speciality. Continuous improvement in pharmacological therapy and operative techniques as well as frequently changing guidelines represent a constant challenge for the individual health-care professional. This review gives a thorough outline of the up-to-date evidence-based management of carotid artery disease and discusses its current controversies. PMID:23197661

Case Report: Perioperative management of a pregnant poly trauma patient for spine fixation surgery.

PubMed

Vandse, Rashmi; Cook, Meghan; Bergese, Sergio

2015-01-01

Trauma is estimated to complicate approximately one in twelve pregnancies, and is currently a leading non-obstetric cause of maternal death. Pregnant trauma patients requiring non-obstetric surgery pose a number of challenges for anesthesiologists. Here we present the successful perioperative management of a pregnant trauma patient with multiple injuries including occult pneumothorax who underwent T9 to L1 fusion in prone position, and address the pertinent perioperative anesthetic considerations and management.

Water Demand Management Strategies and Challenges in the Upper Colorado River Basin

NASA Astrophysics Data System (ADS)

Kuhn, R. E.

2016-12-01

Under the 1922 Colorado River Compact, the Upper Basin (Colorado, New Mexico, Utah, and Wyoming) has flow obligations at Lee Ferry to downstream states and Mexico. The Colorado River Storage Project Act (CRSPA) of 1956 led to the construction of four large storage reservoirs. These provide river regulation to allow the Upper Basin to meet its obligations. Lake Powell, the largest and most important, and Lake Mead are now operated in a coordinated manner under the 2007 Interim Guidelines. Studies show that at current demand levels and if the hydrologic conditions the Basin has experienced since the mid-1980s continue or get drier, reservoir operations, alone, may not provide the necessary water to meet the Upper Basin's obligations. Therefore, the Upper Basin states are now studying demand management strategies that will reduce consumptive uses when total system reservoir storage reaches critically low levels. Demand management has its own economic, political and technical challenges and limitations and will provide new opportunities for applied research. This presentation will discuss some of those strategies, their challenges, and the kinds of information that research could provide to inform demand management.

Chronic Pancreatitis: Current Status and Challenges for Prevention and Treatment.

PubMed

Lew, Daniel; Afghani, Elham; Pandol, Stephen

2017-07-01

This paper reviews the current status of our understanding of the epidemiology, diagnosis, and management of the continuum of pancreatic diseases from acute and recurrent acute pancreatitis to chronic pancreatitis and the diseases that are often linked with pancreatitis including diabetes mellitus and pancreatic cancer. In addition to reviewing the current state of the field, we identify gaps in knowledge that are necessary to address to improve patient outcomes in these conditions.

The new challenges of end-of-life tyres management systems: A Spanish case study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Uruburu, Ángel, E-mail: angel.uruburu@upm.es; Ponce-Cueto, Eva, E-mail: eva.ponce@upm.es; Center for Transportation and Logistics, Massachusetts Institute of Technology, Cambridge, MA

Highlights: ► Impact of the implementation of the Directive 2008/98/EC in Spain for end-of-life tyres. ► Characterization of the reverse supply chain for collecting, recovering, and treating end-of-life tyres. ► Identification of challenges to be coped and issues to be covered. ► Potential new applications for end-of-life tyres and development of new management related strategies. - Abstract: Directive 2008/98/EC released by the European Union represents a significant step forward in all relevant aspects of waste management. Under the already established, extended produced responsibility (EPR) principle, new policies have been enunciated to continuously achieve better overall environmental performance of key productsmore » throughout their life phases. This paper discusses how the directive is being articulated in Spain by the main integrated management system (IMS) for end-of-life (EOL) tyres since its creation in 2006. Focusing on the IMS technological, economic and legal aspects, the study provides a global perspective and evaluation of how the IMS is facing the current issues to resolve, the new challenges that have appeared and the management vision for the coming years.« less

Asan medical information system for healthcare quality improvement.

PubMed

Ryu, Hyeon Jeong; Kim, Woo Sung; Lee, Jae Ho; Min, Sung Woo; Kim, Sun Ja; Lee, Yong Su; Lee, Young Ha; Nam, Sang Woo; Eo, Gi Seung; Seo, Sook Gyoung; Nam, Mi Hyun

2010-09-01

This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. AMIS CONSISTED OF SEVERAL DISTINCTIVE SYSTEMS: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed.

Stabilization of Volar Ulnar Rim Fractures of the Distal Radius: Current Techniques and Review of the Literature

PubMed Central

O'Shaughnessy, Maureen A.; Shin, Alexander Y.; Kakar, Sanjeev

2016-01-01

Background Distal radius fractures involving the lunate facet can be challenging to manage. Reports have shown the volar carpal subluxation/dislocation that can occur if the facet is not appropriately stabilized. Literature Review Recent emphasis in the literature has underscored the difficulty in managing this fracture fragment, suggesting standard volar plates may not be able to adequately stabilize the fragment. This article reviews the current literature with a special emphasis on fixation with a specifically designed fragment-specific hook plate to secure the lunate facet. Case Description An extended flexor carpi radialis volar approach was made which allows access to the distal volar ulnar fracture fragment. Once provisionally stabilized with Kirschner wire fixation, a volar hook plate was applied to capture this fragment. Additional fracture stabilization was used as deemed necessary to stabilize the remaining distal radius fracture. Clinical Relevance The volar marginal rim fragment remains a challenge in distal radius fracture management. Use of a hook plate to address the volar ulnar corner allows for stable fixation without loss of reduction at intermediate-term follow-up. PMID:27104076

Current challenges and realities for forest-based businesses adjacent to public lands in the United States

Treesearch

Emily J. Davis; Jesse Abrams; Eric M. White; Cassandra Moseley

2018-01-01

Through contracting and timber sales, the private sector is engaged in management of national forest lands and local community economies in the United States. But there is little recent research about current relationships between these lands and timber purchasers that could better inform future timber and biomass sale and business assistance policies and programs. We...

Patient-centered applications: use of information technology to promote disease management and wellness. A white paper by the AMIA knowledge in motion working group.

PubMed

Demiris, George; Afrin, Lawrence B; Speedie, Stuart; Courtney, Karen L; Sondhi, Manu; Vimarlund, Vivian; Lovis, Christian; Goossen, William; Lynch, Cecil

2008-01-01

Advances in information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels. New communication technologies can support a transition from institution centric to patient-centric applications. This white paper defines key principles and challenges for designers, policy makers, and evaluators of patient-centered technologies for disease management and prevention. It reviews current and emerging trends; highlights challenges related to design, evaluation, reimbursement and usability; and reaches conclusions for next steps that will advance the domain.

Patient-centered Applications: Use of Information Technology to Promote Disease Management and Wellness. A White Paper by the AMIA Knowledge in Motion Working Group

PubMed Central

Demiris, George; Afrin, Lawrence B.; Speedie, Stuart; Courtney, Karen L.; Sondhi, Manu; Vimarlund, Vivian; Lovis, Christian; Goossen, William; Lynch, Cecil

2008-01-01

Advances in information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels. New communication technologies can support a transition from institution centric to patient-centric applications. This white paper defines key principles and challenges for designers, policy makers, and evaluators of patient-centered technologies for disease management and prevention. It reviews current and emerging trends; highlights challenges related to design, evaluation, reimbursement and usability; and reaches conclusions for next steps that will advance the domain. PMID:17947617

[Shuttle Challenger disaster: what lessons can be learned for management of patients in the operating room?].

PubMed

Suva, Domizio; Poizat, Germain

2015-02-04

For many years hospitals have been implementing crew resource management (CRM) programs, inspired by the aviation industry, in order to improve patient safety. However, while contributing to improved patient care, CRM programs are controversial because of their limited impact, a decrease in effectiveness over time, and the underinvestment by some caregivers. By analyzing the space shuttle Challenger accident, the objective of this article is to show the potential impact of the professional culture in decision-making processes. In addition, to present an approach by cultural factors which are an essential complement to current CRM programs in order to enhance the safety of care.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

The papers in this document comprise the proceedings of the Department of Energy's Twelfth Annual Low-Level Radioactive Waste Management Conference, which was held in Chicago, Illinois, on August 28 and 29, 1990. General subjects addressed during the conference included: mixed waste, low-level radioactive waste tracking and transportation, public involvement, performance assessment, waste stabilization, financial assurance, waste minimization, licensing and environmental documentation, below-regulatory-concern waste, low-level radioactive waste temporary storage, current challenges, and challenges beyond 1990.

The State of Melanoma: Challenges and Opportunities

PubMed Central

Merlino, Glenn; Herlyn, Meenhard; Fisher, David E.; Bastian, Boris C.; Flaherty, Keith T.; Davies, Michael A.; Wargo, Jennifer A.; Curiel-Lewandrowski, Clara; Weber, Michael J.; Leachman, Sancy A.; Soengas, Maria S.; McMahon, Martin; Harbour, J. William; Swetter, Susan M.; Aplin, Andrew E.; Atkins, Michael B.; Bosenberg, Marcus W.; Dummer, Reinhard; Gershenwald, Jeff; Halpern, Allan C.; Herlyn, Dorothee; Karakousis, Giorgos C.; Kirkwood, John M.; Krauthammer, Michael; Lo, Roger S.; Long, Georgina V.; McArthur, Grant; Ribas, Antoni; Schuchter, Lynn; Sosman, Jeffrey A.; Smalley, Keiran S.; Steeg, Patricia; Thomas, Nancy E.; Tsao, Hensin; Tueting, Thomas; Weeraratna, Ashani; Xu, George; Lomax, Randy; Martin, Alison; Silverstein, Steve; Turnham, Tim; Ronai, Ze’ev A.

2017-01-01

The Melanoma Research Foundation (MRF) has charted a comprehensive assessment of the current state of melanoma research and care. Intensive discussions among members of the MRF Scientific Advisory Council and Breakthrough Consortium, a group that included clinicians and scientists, focused on four thematic areas—diagnosis/early detection, prevention, tumor cell dormancy (including metastasis) and therapy (response and resistance). These discussions extended over the course of 2015 and culminated at the Society of Melanoma Research 2015 International Congress in November. Each of the four groups has outlined their thoughts per the current status, challenges and opportunities in the four respective areas. The current state and immediate and long-term needs of the melanoma field, from basic research to clinical management, are presented in the following report. PMID:27087480

Potential for the use of mHealth in the management of cardiovascular disease in Kerala: a qualitative study.

PubMed

Smith, Rebecca; Menon, Jaideep; Rajeev, Jaya G; Feinberg, Leo; Kumar, Raman Krishan; Banerjee, Amitava

2015-11-17

To assess the potential for using mHealth in cardiovascular disease (CVD) management in Kerala by exploring: (1) experiences and challenges of current CVD management; (2) current mobile phone use; (3) expectations of and barriers to mobile phone use in CVD management. Qualitative, semistructured, individual interviews. 5 primary health centres in Ernakulam district, Kerala, India. 15 participants in total from 3 stakeholder groups: 5 patients with CVD and/or its risk factors, 5 physicians treating CVD and 5 Accredited Social Health Activists (ASHAs). Patients were sampled for maximum variation on the basis of age, sex, CVD diagnoses and risk factors. All participants had access to a mobile phone. The main themes identified relating to the current challenges of CVD were poor patient disease knowledge, difficulties in implementing primary prevention and poor patient lifestyles. Participants noted phone calls as the main function of current mobile phone use. The expectations of mHealth use are to: improve accessibility to healthcare knowledge; provide reminders of appointments, medication and lifestyle changes; save time, money and travel; and improve ASHA job efficacy. All perceived barriers to mHealth were noted within physician interviews. These included fears of mobile phones negatively affecting physicians' roles, the usability of mobile phones, radiation and the need for physical consultations. There are three main potential uses of mHealth in this population: (1) as an educational tool, to improve health education and lifestyle behaviours; (2) to optimise the use of limited resources, by overcoming geographical barriers and financial constraints; (3) to improve use of healthcare, by providing appointment and treatment reminders in order to improve disease prevention and management. Successful mHealth design, which takes barriers into account, may complement current practice and optimise use of limited resources. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Potential for the use of mHealth in the management of cardiovascular disease in Kerala: a qualitative study

PubMed Central

Smith, Rebecca; Menon, Jaideep; Rajeev, Jaya G; Feinberg, Leo; Kumar, Raman Krishan; Banerjee, Amitava

2015-01-01

Objectives To assess the potential for using mHealth in cardiovascular disease (CVD) management in Kerala by exploring: (1) experiences and challenges of current CVD management; (2) current mobile phone use; (3) expectations of and barriers to mobile phone use in CVD management. Design Qualitative, semistructured, individual interviews. Setting 5 primary health centres in Ernakulam district, Kerala, India. Participants 15 participants in total from 3 stakeholder groups: 5 patients with CVD and/or its risk factors, 5 physicians treating CVD and 5 Accredited Social Health Activists (ASHAs). Patients were sampled for maximum variation on the basis of age, sex, CVD diagnoses and risk factors. All participants had access to a mobile phone. Results The main themes identified relating to the current challenges of CVD were poor patient disease knowledge, difficulties in implementing primary prevention and poor patient lifestyles. Participants noted phone calls as the main function of current mobile phone use. The expectations of mHealth use are to: improve accessibility to healthcare knowledge; provide reminders of appointments, medication and lifestyle changes; save time, money and travel; and improve ASHA job efficacy. All perceived barriers to mHealth were noted within physician interviews. These included fears of mobile phones negatively affecting physicians’ roles, the usability of mobile phones, radiation and the need for physical consultations. Conclusions There are three main potential uses of mHealth in this population: (1) as an educational tool, to improve health education and lifestyle behaviours; (2) to optimise the use of limited resources, by overcoming geographical barriers and financial constraints; (3) to improve use of healthcare, by providing appointment and treatment reminders in order to improve disease prevention and management. Successful mHealth design, which takes barriers into account, may complement current practice and optimise use of limited resources. PMID:26576813

Identifying challenges for academic leadership in medical universities in Iran.

PubMed

Bikmoradi, Ali; Brommels, Mats; Shoghli, Alireza; Khorasani-Zavareh, Davoud; Masiello, Italo

2010-05-01

CONTEXT The crucial role of academic leadership in the success of higher education institutions is well documented. Medical education in Iran has been integrated into the health care system through a complex organisational change. This has called into question the current academic leadership, making Iranian medical universities and schools a good case for exploring the challenges of academic leadership. OBJECTIVES This study explores the leadership challenges perceived by academic managers in medical schools and universities in Iran. METHODS A qualitative study using 18 face-to-face, in-depth interviews with academic managers in medical universities and at the Ministry of Health and Medical Education in Iran was performed. All interviews were recorded digitally, transcribed verbatim and analysed by qualitative content analysis. RESULTS The main challenges to academic leadership could be categorised under three themes, each of which included three sub-themes: organisational issues (inefficacy of academic governance; an overly extensive set of missions and responsibilities; concerns about the selection of managers); managerial issues (management styles; mismatch between authority and responsibilities; leadership capabilities), and organisational culture (tendency towards governmental management; a boss-centred culture; low motivation). CONCLUSIONS This study emphasises the need for academic leadership development in Iranian medical schools and universities. The ability of Iranian universities to grow and thrive will depend ultimately upon the application of leadership skills. Thus, it is necessary to better designate authorities, roles of academic staff and leaders at governance.

Toward fisheries sustainability in North America: Issues, challenges, and strategies for action

USGS Publications Warehouse

MacDonald, D.D.; Knudsen, E.E.

2004-01-01

Many fisheries in North America are severely depleted and trending downwards. In an effort to find ways of reversing this disturbing situation, the American Fisheries Society and the Sustainable Fisheries Foundation invited leading experts in fisheries science and aquatic resource management to share their thoughts and insights in this book. These experts were asked to identify the factors that are currently impairing our ability to effectively manage fisheries resources and propose creative solutions for addressing the most challenging issues affecting fisheries sustainability. Based on the information that was provided by the experts (i.e., as presented in the earlier chapters of this book), it is apparent that a wide range of human activities are adversely affecting our shared fisheries resources and the aquatic habitats upon which they depend. The most challenging problems stem from causes that are largely beyond the scope of traditional fisheries management (e.g., human population growth, resource consumption patterns, global climate change, broad land-use patterns). It is also apparent that resolution of these challenges will require a new approach to fisheries management - one that effectively integrates economic, social, and environmental interests into a decision-making framework that supports fisheries sustainability. The key strategies for supporting such a transition toward a more holistic and comprehensive approach to managing the human activities that influence fisheries and aquatic resources are summarized in this chapter. ?? 2004 by the American Fisheries Society.

Recommendations for sexual expression management in long-term care: a qualitative needs assessment

PubMed Central

Syme, Maggie L.; Lichtenberg, Peter; Moye, Jennifer

2017-01-01

Aims To conduct a qualitative needs assessment of Directors of Nursing regarding challenges and recommendations for addressing sexual expression and consent. Background Sexual expression management among long-term care residents is a complex issue for nursing home staff. Little guidance is available for those wanting to follow a person-centred approach. Policies and procedures are needed, and must be usable across long-term care settings. Design Qualitative design for in-depth exploration. Methods Semi-structured interviews were conducted with 20 Directors of Nursing in the spring and summer of 2013, representing a range of regions, facility sizes and resident populations. Interview questions prompted them to identify recommendations that address challenges to improving sexual expression management in long-term care settings. Results Comparative thematic analysis resulted in several codes, which were grouped into eight overall categories. Recommendation categories that addressed key challenges included: address the issue, make environmental changes, identify staff expertise, provide education and training, assess sexuality initially and recurrently, establish policies/procedures for sexual expression management, develop assessment tools for sexual expression and consent, and clarify legal issues. The recommendation to develop national guidelines was observed across categories. Discussion Directors of Nursing report several challenges to sexual expression management in their facilities, and perceive their current methods to be ad hoc. A proactive approach to policy and procedure development is needed. PMID:27188413

MAVEN Information Security Governance, Risk Management, and Compliance (GRC): Lessons Learned

NASA Technical Reports Server (NTRS)

Takamura, Eduardo; Gomez-Rosa, Carlos A.; Mangum, Kevin; Wasiak, Fran

2014-01-01

As the first interplanetary mission managed by the NASA Goddard Space Flight Center, the Mars Atmosphere and Volatile EvolutioN (MAVEN) had three IT security goals for its ground system: COMPLIANCE, (IT) RISK REDUCTION, and COST REDUCTION. In a multiorganizational environment in which government, industry and academia work together in support of the ground system and mission operations, information security governance, risk management, and compliance (GRC) becomes a challenge as each component of the ground system has and follows its own set of IT security requirements. These requirements are not necessarily the same or even similar to each other's, making the auditing of the ground system security a challenging feat. A combination of standards-based information security management based on the National Institute of Standards and Technology (NIST) Risk Management Framework (RMF), due diligence by the Mission's leadership, and effective collaboration among all elements of the ground system enabled MAVEN to successfully meet NASA's requirements for IT security, and therefore meet Federal Information Security Management Act (FISMA) mandate on the Agency. Throughout the implementation of GRC on MAVEN during the early stages of the mission development, the Project faced many challenges some of which have been identified in this paper. The purpose of this paper is to document these challenges, and provide a brief analysis of the lessons MAVEN learned. The historical information documented herein, derived from an internal pre-launch lessons learned analysis, can be used by current and future missions and organizations implementing and auditing GRC.

The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction.

PubMed

Tintoré, Mar; Alexander, Maggie; Costello, Kathleen; Duddy, Martin; Jones, David E; Law, Nancy; O'Neill, Gilmore; Uccelli, Antonio; Weissert, Robert; Wray, Sibyl

2017-01-01

Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment.

The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction

PubMed Central

Tintoré, Mar; Alexander, Maggie; Costello, Kathleen; Duddy, Martin; Jones, David E; Law, Nancy; O’Neill, Gilmore; Uccelli, Antonio; Weissert, Robert; Wray, Sibyl

2017-01-01

Background Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. Methods A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. Results A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. Conclusion Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment. PMID:28053511

Current Trends in the Management of Blunt Solid Organ Injuries.

PubMed

Taviloglu, Korhan; Yanar, Hakan

2009-04-01

The management of patients with solid organ injuries has changed since the introduction of technically advanced imaging tools, such as ultrasonography and multiple scan computerized tomography, interventional radiological techniques and modern intensive care units. In spite of this development in the management of these patients, major solid organ traumas can still be challenging. There has been great improvement in the non-operative management (NOM) of intra-abdominal solid organ injury in recent decades. In most cases treatment of injuries has shifted from early surgical treatment to NOM.

The impact of health information technology on collaborative chronic care management.

PubMed

Marchibroda, Janet M

2008-03-01

Chronic disease is a growing problem in the United States. More than 125 million Americans had at least 1 chronic care condition in 2000, and this number is expected to grow to 157 million by the year 2020.1 Some of the challenges associated with current chronic care management approaches can be addressed through the use of health information technology (IT) and health information exchange. To review the current challenges of chronic care management and explore how health IT and health information exchange efforts at the national, state, and local levels can be leveraged to address some of these challenges. Efforts to effectively manage chronic care have been hampered by a number of factors, including a fragmented health care system and the need for more coordination across the health care setting; the lack of interoperable clinical information systems, which would help provide readily available, comprehensive information about the patient to those who deliver care, those who manage care, and those who receive care, and finally, the current predominantly fee-for-service reimbursement system that rewards volume and fragmentation, and does not effectively align incentives with the goals of chronic care management. The introduction of health IT, including electronic health records and health information exchange, holds great promise for addressing many of the barriers to effective chronic care management, by providing important clinical information about the patient when it is needed, and where it is needed, in a timely, secure fashion. Having information from the care delivery process readily available through health IT and health information exchange at the national, state, and local levels supports key components of the chronic care management process, including those related to measurement, clinical decision support, collaboration and coordination, and consumer activation. Those engaged in chronic care management should seek to leverage health IT and health information exchange initiatives particularly at the local levels. Community-based initiatives have built social capital and trust across multiple stakeholders; enabled access to clinical data derived from the care delivery process that only resides locally; and in many cases aligned incentives around the mobilization of clinical information across care settings. All of these elements are critical to the long-term success of chronic care management. While there is good research regarding interdisciplinary care models, more research is still needed to identify policies, practices, and strategies for facilitating and building cooperation among those engaged in chronic care management, and those engaged in multi-stakeholder efforts involved in the exchange of clinical health information electronically.

Managers’ perspectives: practical experience and challenges associated with variable-density operations and uneven-aged management

Treesearch

Kurtis E. Steele

2013-01-01

Variable-density thinning has received a lot of public attention in recent years and has subsequently become standard language in most of the Willamette National Forest’s timber management projects. Many techniques have been tried, with varying on-the-ground successes. To accomplish variable-density thinning, the McKenzie River Ranger District currently uses...

Evolving the policy framework: Budget strategies, legislative authorities, and management strategies to facilitate federal forest adaptation and collaborative partnerships

Treesearch

Christopher Topik; Paige Lewis

2014-01-01

Some of the greatest challenges to the management of federal forests in the Unites States result from inadequate public and private investment in proactive forest restoration projects. This situation has been exacerbated by the growing fiscal and logistical demands of wildfire suppression activities, which currently consume at least 40 percent of the U.S. Forest...

Information revolution in nursing and health care: educating for tomorrow's challenge.

PubMed

Kooker, B M; Richardson, S S

1994-06-01

Current emphasis on the national electronic highway and a national health database for comparative health care reporting demonstrates society's increasing reliance on information technology. The efficient electronic processing and managing of data, information, and knowledge are critical for survival in tomorrow's health care organization. To take a leadership role in this information revolution, informatics nurse specialists must possess competencies that incorporate information science, computer science, and nursing science for successful information system development. In selecting an appropriate informatics educational program or to hire an individual capable of meeting this challenge, nurse administrators must look for the following technical knowledge and skill set: information management principles, system development life cycle, programming languages, file design and access, hardware and network architecture, project management skills, and leadership abilities.

Supported self-management for cancer survivors to address long-term biopsychosocial consequences of cancer and treatment to optimize living well.

PubMed

Howell, Doris D

2018-03-01

As individuals are living longer with cancer as a chronic disease, they face new health challenges that require the application of self-management behaviors and skills that may not be in their usual repertoire of self-regulatory health behaviors. Increasing attention is focused on supported self-management (SSM) programs to enable survivors in managing the long-term biopsychosocial consequences and health challenges of survivorship. This review explores current directions and evidence for SSM programs that enable survivors to manage these consequences and optimize health. Cancer survivors face complex health challenges that affect daily functioning and well being. Multiple systematic reviews show that SSM programs have positive effects on health outcomes in typical chronic diseases. However, the efficacy of these approaches in cancer survivors are in their infancy; and the 'one-size' fits all approach for chronic disease self-management may not be adequate for cancer as a complex chronic illness. This review suggests that SSM has promising potential for improving health and well being of cancer survivors, but there is a need for standardizing SSM for future research. Although there is increasing enthusiasm for SSM programs tailored to cancer survivors, there is a need for further research of their efficacy on long-term health outcomes.

Health and Safety Advisory Committee (HASAC) of the International Embryo Transfer Society (IETS) has managed critical challenges for two decades.

PubMed

Thibier, M; Stringfellow, D A

2003-02-01

The International Embryo Transfer Society (IETS) was founded in 1974. Early members used the society as a forum for the exchange of scientific and technical information relevant to a newly emerging embryo transfer industry. The impact that embryo transfer could have on the international trade of livestock genetics was clear by 1982, so the IETS commissioned the Import/Export Committee. The initial challenge for this Committee was to deal with concerns about disease transmission via embryo transfer. Many of the early concerns have been dispelled, but at the time they threatened the continued development of a fledgling industry. Over the past two decades, many new critical challenges have been met and managed by this Committee, which was recently renamed the Health and Safety Advisory Committee (HASAC). Assessing risks of animal disease transmission via reproductive technologies and establishing protocols for managing these risks are still major issues for HASAC. However, additional concerns have developed as views of the society changed and as novel applications of biotechnology in farm animals were identified. This paper is intended to chronicle some of the major changes and challenges that were managed by members of the HASAC and its Subcommittees from the early years of embryo transfer to the current millennium with technological advances in molecular biology.

Challenges in managing elderly people with diabetes in primary care settings in Norway

PubMed Central

2013-01-01

Abstract Objective To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings. Design Focus-group interviews. Subjects and setting Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32–59 years with clinical experience ranging from 1.5 to 38 years. Results Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines. Conclusion Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging. PMID:24205973

Chronic disease management and the home-care alternative in Ontario, Canada.

PubMed

Tsasis, Peter

2009-08-01

The pressure on our health-care system to deliver efficient, quality and cost-effective care is increasing. The debate on its sustainability is also expanding. These challenges can be managed with revisions to our health-care policy frameworks governing how and what public health-care services are delivered. Chronic disease management and home care can together ease many of the present and future pressures facing the health-care system. However, the current level of investment and the present policy are not effectively supporting movement in this direction. Updating the Canada Health Act to reflect the realities of our health-care system, and developing policies to support the areas of interdisciplinary teamwork and system integration are needed to facilitate chronic disease management and home care in Canada. This article lays out the challenges, highlights the impending issues and suggests a framework for moving forward.

Quality, risk management and governance in mental health: an overview.

PubMed

Callaly, Tom; Arya, Dinesh; Minas, Harry

2005-03-01

To consider the origin, current emphasis and relevance of the concepts of quality, risk management and clinical governance in mental health. Increasingly, health service boards and management teams are required to give attention to clinical governance rather than corporate governance alone. Clinical governance is a unifying quality concept that aims to produce a structure and systems to assure and improve the quality of clinical services by promoting an integrated and organization-wide approach towards continuous quality improvement. Many psychiatrists will find the reduction in clinical autonomy, the need to consider the welfare of the whole population as well as the individual patient for whom they are responsible, and the requirement that they play a part in a complex systems approach to quality improvement to be a challenge. Avoiding or ignoring this challenge will potentially lead to conflict with modern management approaches and increased loss of influence on future developments in mental health services.

Neuronavigation in the surgical management of brain tumors: current and future trends

PubMed Central

Orringer, Daniel A; Golby, Alexandra; Jolesz, Ferenc

2013-01-01

Neuronavigation has become an ubiquitous tool in the surgical management of brain tumors. This review describes the use and limitations of current neuronavigational systems for brain tumor biopsy and resection. Methods for integrating intraoperative imaging into neuronavigational datasets developed to address the diminishing accuracy of positional information that occurs over the course of brain tumor resection are discussed. In addition, the process of integration of functional MRI and tractography into navigational models is reviewed. Finally, emerging concepts and future challenges relating to the development and implementation of experimental imaging technologies in the navigational environment are explored. PMID:23116076

Joint search and sensor management for geosynchronous satellites

NASA Astrophysics Data System (ADS)

Zatezalo, A.; El-Fallah, A.; Mahler, R.; Mehra, R. K.; Pham, K.

2008-04-01

Joint search and sensor management for space situational awareness presents daunting scientific and practical challenges as it requires a simultaneous search for new, and the catalog update of the current space objects. We demonstrate a new approach to joint search and sensor management by utilizing the Posterior Expected Number of Targets (PENT) as the objective function, an observation model for a space-based EO/IR sensor, and a Probability Hypothesis Density Particle Filter (PHD-PF) tracker. Simulation and results using actual Geosynchronous Satellites are presented.

Scientific Workflow Management in Proteomics

PubMed Central

de Bruin, Jeroen S.; Deelder, André M.; Palmblad, Magnus

2012-01-01

Data processing in proteomics can be a challenging endeavor, requiring extensive knowledge of many different software packages, all with different algorithms, data format requirements, and user interfaces. In this article we describe the integration of a number of existing programs and tools in Taverna Workbench, a scientific workflow manager currently being developed in the bioinformatics community. We demonstrate how a workflow manager provides a single, visually clear and intuitive interface to complex data analysis tasks in proteomics, from raw mass spectrometry data to protein identifications and beyond. PMID:22411703

ADMS State of the Industry and Gap Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Agalgaonkar, Yashodhan P.; Marinovici, Maria C.; Vadari, Subramanian V.

2016-03-31

An Advanced distribution management system (ADMS) is a platform for optimized distribution system operational management. This platform comprises of distribution management system (DMS) applications, supervisory control and data acquisition (SCADA), outage management system (OMS), and distributed energy resource management system (DERMS). One of the primary objectives of this work is to study and analyze several ADMS component and auxiliary systems. All the important component and auxiliary systems, SCADA, GISs, DMSs, AMRs/AMIs, OMSs, and DERMS, are discussed in this report. Their current generation technologies are analyzed, and their integration (or evolution) with an ADMS technology is discussed. An ADMS technology statemore » of the art and gap analysis is also presented. There are two technical gaps observed. The integration challenge between the component operational systems is the single largest challenge for ADMS design and deployment. Another significant challenge noted is concerning essential ADMS applications, for instance, fault location, isolation, and service restoration (FLISR), volt-var optimization (VVO), etc. There are a relatively small number of ADMS application developers as ADMS software platform is not open source. There is another critical gap and while not being technical in nature (when compared the two above) is still important to consider. The data models currently residing in utility GIS systems are either incomplete or inaccurate or both. This data is essential for planning and operations because it is typically one of the primary sources from which power system model are created. To achieve the full potential of ADMS, the ability to execute acute Power Flow solution is an important pre-requisite. These critical gaps are hindering wider Utility adoption of an ADMS technology. The development of an open architecture platform can eliminate many of these barriers and also aid seamless integration of distribution Utility legacy systems with an ADMS.« less

Chronic Pancreatitis: Current Status and Challenges for Prevention and Treatment

PubMed Central

Lew, Daniel; Afghani, Elham

2017-01-01

This paper reviews the current status of our understanding of the epidemiology, diagnosis, and management of the continuum of pancreatic diseases from acute and recurrent acute pancreatitis to chronic pancreatitis and the diseases that are often linked with pancreatitis including diabetes mellitus and pancreatic cancer. In addition to reviewing the current state of the field, we identify gaps in knowledge that are necessary to address to improve patient outcomes in these conditions. PMID:28501969

Optimizing anaerobic soil disinfestation for soilborne disease control

USDA-ARS?s Scientific Manuscript database

Soilborne disease management without chemical fumigants is a major challenge for strawberry production in California. Current re-registrations and regulations are likely to intensify this obstacle by severely limiting availability of fumigants on a large percentage of strawberry acreage. Anaerobic s...

COST MODELS FOR WATER SUPPLY DISTRIBUTION SYSTEMS

EPA Science Inventory

A major challenge for society in the twenty-first century will be replacement, design and optimal management of urban infrastructure. It is estimated that the current world wide demand for infrastructure investment is approximately three trillion dollars annually. A Drinking Wate...

Snowmass Computing Frontier: Computing for the Cosmic Frontier, Astrophysics, and Cosmology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Connolly, A.; Habib, S.; Szalay, A.

2013-11-12

This document presents (off-line) computing requrements and challenges for Cosmic Frontier science, covering the areas of data management, analysis, and simulations. We invite contributions to extend the range of covered topics and to enhance the current descriptions.

Why Don't They Just Give Us Money? Project Cost Estimating and Cost Reporting

NASA Technical Reports Server (NTRS)

Comstock, Douglas A.; Van Wychen, Kristin; Zimmerman, Mary Beth

2015-01-01

Successful projects require an integrated approach to managing cost, schedule, and risk. This is especially true for complex, multi-year projects involving multiple organizations. To explore solutions and leverage valuable lessons learned, NASA's Virtual Project Management Challenge will kick off a three-part series examining some of the challenges faced by project and program managers when it comes to managing these important elements. In this first session of the series, we will look at cost management, with an emphasis on the critical roles of cost estimating and cost reporting. By taking a proactive approach to both of these activities, project managers can better control life cycle costs, maintain stakeholder confidence, and protect other current and future projects in the organization's portfolio. Speakers will be Doug Comstock, Director of NASA's Cost Analysis Division, Kristin Van Wychen, Senior Analyst in the GAO Acquisition and Sourcing Management Team, and Mary Beth Zimmerman, Branch Chief for NASA's Portfolio Analysis Branch, Strategic Investments Division. Moderator Ramien Pierre is from NASA's Academy for Program/Project and Engineering Leadership (APPEL).

Informing Environmental Water Management Decisions: Using Conditional Probability Networks to Address the Information Needs of Planning and Implementation Cycles.

PubMed

Horne, Avril C; Szemis, Joanna M; Webb, J Angus; Kaur, Simranjit; Stewardson, Michael J; Bond, Nick; Nathan, Rory

2018-03-01

One important aspect of adaptive management is the clear and transparent documentation of hypotheses, together with the use of predictive models (complete with any assumptions) to test those hypotheses. Documentation of such models can improve the ability to learn from management decisions and supports dialog between stakeholders. A key challenge is how best to represent the existing scientific knowledge to support decision-making. Such challenges are currently emerging in the field of environmental water management in Australia, where managers are required to prioritize the delivery of environmental water on an annual basis, using a transparent and evidence-based decision framework. We argue that the development of models of ecological responses to environmental water use needs to support both the planning and implementation cycles of adaptive management. Here we demonstrate an approach based on the use of Conditional Probability Networks to translate existing ecological knowledge into quantitative models that include temporal dynamics to support adaptive environmental flow management. It equally extends to other applications where knowledge is incomplete, but decisions must still be made.

Informing Environmental Water Management Decisions: Using Conditional Probability Networks to Address the Information Needs of Planning and Implementation Cycles

NASA Astrophysics Data System (ADS)

Horne, Avril C.; Szemis, Joanna M.; Webb, J. Angus; Kaur, Simranjit; Stewardson, Michael J.; Bond, Nick; Nathan, Rory

2018-03-01

One important aspect of adaptive management is the clear and transparent documentation of hypotheses, together with the use of predictive models (complete with any assumptions) to test those hypotheses. Documentation of such models can improve the ability to learn from management decisions and supports dialog between stakeholders. A key challenge is how best to represent the existing scientific knowledge to support decision-making. Such challenges are currently emerging in the field of environmental water management in Australia, where managers are required to prioritize the delivery of environmental water on an annual basis, using a transparent and evidence-based decision framework. We argue that the development of models of ecological responses to environmental water use needs to support both the planning and implementation cycles of adaptive management. Here we demonstrate an approach based on the use of Conditional Probability Networks to translate existing ecological knowledge into quantitative models that include temporal dynamics to support adaptive environmental flow management. It equally extends to other applications where knowledge is incomplete, but decisions must still be made.

Management of intracerebral hemorrhage.

PubMed

Thabet, A M; Kottapally, M; Hemphill, J Claude

2017-01-01

Intracerebral hemorrhage (ICH) is a potentially devastating neurologic injury representing 10-15% of stroke cases in the USA each year. Numerous risk factors, including age, hypertension, male gender, coagulopathy, genetic susceptibility, and ethnic descent, have been identified. Timely identification, workup, and management of this condition remain a challenge for clinicians as numerous factors can present obstacles to achieving good functional outcomes. Several large clinical trials have been conducted over the prior decade regarding medical and surgical interventions. However, no specific treatment has shown a major impact on clinical outcome. Current management guidelines do exist based on medical evidence and consensus and these provide a framework for care. While management of hypertension and coagulopathy are generally considered basic tenets of ICH management, a variety of measures for surgical hematoma evacuation, intracranial pressure control, and intraventricular hemorrhage can be further pursued in the emergent setting for selected patients. The complexity of management in parenchymal cerebral hemorrhage remains challenging and offers many areas for further investigation. A systematic approach to the background, pathology, and early management of spontaneous parenchymal hemorrhage is provided. © 2017 Elsevier B.V. All rights reserved.

Blackbrush (Coleogyne ramosissima Torr.): State of our knowledge and future challenges

USGS Publications Warehouse

Pendleton, Rosemary L.; Pendleton, Burton K.; Meyer, Susan E.; Richardson, Bryce A.; Esque, Todd C.; Kitchen, Stanley G.

2015-01-01

Covering 130,000 square miles and a wide range of elevations from desert to alpine in Arizona, Utah, Colorado, and New Mexico, the Colorado Plateau has long fascinated researchers. The Colorado Plateau VI provides readers with a plethora of updates and insights into land conservation and management questions currently surrounding the region. The Colorado Plateau VI’s contributors show how new technologies for monitoring, spatial analysis, restoration, and collaboration improve our understanding, management, and conservation of outcomes at the appropriate landscape scale for the Colorado Plateau. The volume’s chapters fall into five major themes: monitoring as a key tool for addressing management challenges, restoration approaches to improving ecosystem condition and function, collaboration and organizational innovations to achieve conservation and management objectives, landscape-scale approaches to understanding, and managing key species and ecological communities. Focusing on the integration of science into resource management issues over the Colorado Plateau, this volume includes contributions from dozens of leading scholars of the region. The Colorado Plateau VI proves a valuable resource to all interested in the conservation management, natural history, and cultural biological resources of the Colorado Plateau.

Substance use disorders in military veterans: prevalence and treatment challenges

PubMed Central

Teeters, Jenni B; Lancaster, Cynthia L; Brown, Delisa G; Back, Sudie E

2017-01-01

Substance use disorders (SUDs) are a significant problem among our nation’s military veterans. In the following overview, we provide information on the prevalence of SUDs among military veterans, clinical characteristics of SUDs, options for screening and evidence-based treatment, as well as relevant treatment challenges. Among psychotherapeutic approaches, behavioral interventions for the management of SUDs typically involve short-term, cognitive-behavioral therapy interventions. These interventions focus on the identification and modification of maladaptive thoughts and behaviors associated with increased craving, use, or relapse to substances. Additionally, client-centered motivational interviewing approaches focus on increasing motivation to engage in treatment and reduce substance use. A variety of pharmacotherapies have received some support in the management of SUDs, primarily to help with the reduction of craving or withdrawal symptoms. Currently approved medications as well as treatment challenges are discussed. PMID:28919834

Challenges in Hospital-Associated Infection Management: A Unit Perspective.

PubMed

Stacy, Kathleen M

2015-01-01

Maintaining a successful unit-based continuous quality improvement program for managing hospital-associated infections is a huge challenge and an overwhelming task. It requires strong organizational support and unit leadership, human and fiscal resources, time, and a dedicated and motivated nursing staff. A great deal of effort goes into implementing, monitoring, reporting, and evaluating quality improvement initiatives and can lead to significant frustration on the part of the leadership team and nursing staff when quality improvement efforts fail to produce the desired results. Each initiative presents its own unique set of challenges; however, common issues influence all initiatives. These common issues include organization and unit culture, current clinical practice guidelines being used to drive the initiatives, performance discrepancies on the part of nursing staff, availability of resources including equipment and supplies, monitoring of the data, and conflicting quality improvement priorities.

Weight management in obese pets: the tailoring concept and how it can improve results.

PubMed

German, Alexander J

2016-10-20

Obesity is now recognised as the most important medical disease in pets worldwide. All current strategies for weight management involve dietary energy restriction with a purpose-formulated diet. Whilst current weight management regimes can be successful, outcomes are often disappointing with the rate of weight loss progressively slowing down as time goes on. Success is most challenging for the most obese dogs and cats that are more likely to discontinue the programme before reaching target weight. To improve outcomes, clinicians must focus carefully on better tailoring programmes, paying particular to setting an appropriate target weight so as to maximise the benefits for the individual. In this opinionated review, the author will discuss findings from recent clinical research studies examining weight management in obese dogs and cats. A strategy for tailoring weight management targets will then be discussed, illustrated with case examples.

Knowledge management and informatics considerations for comparative effectiveness research: a case-driven exploration.

PubMed

Embi, Peter J; Hebert, Courtney; Gordillo, Gayle; Kelleher, Kelly; Payne, Philip R O

2013-08-01

As clinical data are increasingly collected and stored electronically, their potential use for comparative effectiveness research (CER) grows. Despite this promise, challenges face those wishing to leverage such data. In this paper we aim to enumerate some of the knowledge management and informatics issues common to such data reuse. After reviewing the current state of knowledge regarding biomedical informatics challenges and best practices related to CER, we then present 2 research projects at our institution. We analyze these and highlight several common themes and challenges related to the conduct of CER studies. Finally, we represent these emergent themes. The informatics challenges commonly encountered by those conducting CER studies include issues related to data information and knowledge management (eg, data reuse, data preparation) as well as those related to people and organizational issues (eg, sociotechnical factors and organizational factors). Examples of these are described in further detail and a formal framework for describing these findings is presented. Significant challenges face researchers attempting to use often diverse and heterogeneous datasets for CER. These challenges must be understood in order to be dealt with successfully and can often be overcome with the appropriate use of informatics best practices. Many research and policy questions remain to be answered in order to realize the full potential of the increasingly electronic clinical data available for such research.

Big Data Challenges for Large Radio Arrays

NASA Technical Reports Server (NTRS)

Jones, Dayton L.; Wagstaff, Kiri; Thompson, David; D'Addario, Larry; Navarro, Robert; Mattmann, Chris; Majid, Walid; Lazio, Joseph; Preston, Robert; Rebbapragada, Umaa

2012-01-01

Future large radio astronomy arrays, particularly the Square Kilometre Array (SKA), will be able to generate data at rates far higher than can be analyzed or stored affordably with current practices. This is, by definition, a "big data" problem, and requires an end-to-end solution if future radio arrays are to reach their full scientific potential. Similar data processing, transport, storage, and management challenges face next-generation facilities in many other fields.

Projections of timber harvest in western Oregon and Washington by county, owner, forest type, and age class.

Treesearch

Xiaoping Zhou; Richard W. Haynes; R. James. Barbour

2005-01-01

The Pacific Northwest forest resource is highly dynamic. Expected changes over the next 50 years will greatly challenge some current perceptions of resource managers and various stakeholders. This report describes the current and expected future timberland conditions of western Oregon and Washington and presents the results at the county level. About 50 percent of the...

Survey of business process management: challenges and solutions

NASA Astrophysics Data System (ADS)

Alotaibi, Youseef; Liu, Fei

2017-09-01

The current literature shows that creating a good framework on business process model (PM) is not an easy task. A successful business PM should have the ability to ensure accurate alignment between business processes (BPs) and information technology (IT) designs, provide security protection, manage the rapidly changing business environment and BPs, manage customer power, be flexible for reengineering and ensure that IT goals can be easily derived from business goals and hence an information system (IS) can be easily implemented. This article presents an overview of research in the business PM domain. We have presented a review of the challenges facing business PMs, such as misalignment between business and IT, difficulty of deriving IT goals from business goals, creating secured business PM, reengineering BPs, managing the rapidly changing BP and business environment and managing customer power. Also, it presents the limitations of existing business PM frameworks. Finally, we outline several guidelines to create good business PM and the possible further research directions in the business PM domain.

Diagnosis and management of neuropathic pain: a balanced approach to treatment.

PubMed

Nicholson, Bruce D

2003-12-01

To provide nurse practitioners with a conceptual framework from which to diagnose and manage chronic neuropathic pain, specifically postherpetic neuralgia (PHN). A current review of the available treatment options for the management of neuropathic pain and PHN is provided. A comprehensive literature review was conducted. Clinical articles, meta-analyses, and reviews were selected for their relevance to the diagnosis and management of chronic neuropathic pain and PHN. Managing patients with chronic neuropathic pain is a common clinical challenge due to variability in individual symptoms, mechanisms, and treatment responses. In patients with PHN, a balanced treatment approach focusing on efficacy, safety, and tolerability is recommended. With appropriate treatment, most patients are able to achieve clinically significant relief from neuropathic pain. Diagnosis and management of neuropathic pain syndromes is challenging. Because of the complexity of chronic pain, successful long-term treatment can be especially difficult (Nicholson, 2003b). While most acute pain is nociceptive (i.e., a response to noxious stimuli), chronic pain can be nociceptive, neuropathic, or of mixed origin. PHN is a chronic pain syndrome that can last for years, causing physical and social disability and psychological distress (Kanazi, 2000). Despite major recent advances in the treatment of PHN, many patients remain refractory to current therapy (Dworkin, 2003). For practicing clinicians, including nurse practitioners, viewing pain as a disease rather than a symptom is the first step towards its successful management. Understanding the pathophysiology of chronic pain and emerging treatment paradigms for the management of neuropathic pain and PHN is critical to optimal care.

Using Satellite Data to Unpack Causes of Yield Gaps in India's Wheat Belt

NASA Astrophysics Data System (ADS)

Jain, M.; Singh, B.; Srivastava, A.; Malik, R. K.; McDonald, A.; Lobell, D. B.

2016-12-01

India will face significant food security challenges in the coming decades due to climate change, natural resource degradation, and population growth. Yields of wheat, one of India's staple crops, are already stagnating and will be significantly impacted by warming temperatures. Despite these challenges, wheat yields can be enhanced by implementing improved management in regions with existing yield gaps. To identify the magnitude and causes of current yield gaps, we produced 30 m resolution yield maps across India's main wheat belt, the Indo-Gangetic Plains (IGP), from 2000 to 2015. Yield maps were derived using a new method that translates satellite vegetation indices to yield estimates using crop model simulations, bypassing the need for ground calibration data that rarely exist in smallholder systems. We find that yields can be increased by 5% on average and up to 16% in the eastern IGP by improving management to current best practices within a given district. However, if policies and technologies are put in place to improve management to current best practices in Punjab, the highest yielding state, yields can be increased by 29% in the eastern IGP. Considering which factors most influence wheat yields, we find that later sow dates and warmer temperatures are most associated with low yields across the IGP. This suggests that strategies that reduce the negative effects of heat stress, like earlier sowing and planting heat-tolerant wheat varieties, are critical to India's current and future food security.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marshall, Rachael E., E-mail: rmarsh01@uoguelph.ca; Farahbakhsh, Khosrow, E-mail: khosrowf@uoguelph.ca

Highlights: ► Five drivers led developed countries to current solid waste management paradigm. ► Many unique factors challenge developing country solid waste management. ► Limited transferability of developed country approaches to developing countries. ► High uncertainties and decision stakes call for post-normal approaches. ► Systems thinking needed for multi-scale, self-organizing eco-social waste systems. - Abstract: Solid waste management (SWM) has become an issue of increasing global concern as urban populations continue to rise and consumption patterns change. The health and environmental implications associated with SWM are mounting in urgency, particularly in the context of developing countries. While systems analyses largelymore » targeting well-defined, engineered systems have been used to help SWM agencies in industrialized countries since the 1960s, collection and removal dominate the SWM sector in developing countries. This review contrasts the history and current paradigms of SWM practices and policies in industrialized countries with the current challenges and complexities faced in developing country SWM. In industrialized countries, public health, environment, resource scarcity, climate change, and public awareness and participation have acted as SWM drivers towards the current paradigm of integrated SWM. However, urbanization, inequality, and economic growth; cultural and socio-economic aspects; policy, governance, and institutional issues; and international influences have complicated SWM in developing countries. This has limited the applicability of approaches that were successful along the SWM development trajectories of industrialized countries. This review demonstrates the importance of founding new SWM approaches for developing country contexts in post-normal science and complex, adaptive systems thinking.« less

The role of managed care in work-related injuries.

PubMed

Shor, M J; Miller, J C

1996-10-01

Many opportunities exist today for orthopedic surgeons in the treatment and management of work-related injuries. Physicians wishing to enter or participate in this market must realize that the role of the physician in the treatment of the injured worker has expanded from one of being solely the care giver to being a patient manager, a problem solver, and a communicator. A number of years ago, many orthopedic surgeons missed out on managed care contracting for health maintenance organizations because they thought they could survive without it. They soon learned the challenges of sitting on the sidelines. Whether we like it or not, managed care for work-related injuries is here and its likelihood for going away is about zero. If your state has not yet adopted utilization management standards or managed care for workers' compensation-enabling legislation, when you wake up tomorrow they may have done so. Because of its relative embryonic development, there are exceptional opportunities for practitioners to take active roles in shaping the models that will serve employees and employers in the year 2000. Physicians who are interested in the treatment of injured workers have a unique opportunity right now to develop relationships in the managed workers' compensation arena. Payment and patient referrals for workers' compensation may turn out to be more attractive financially than many of the contracts currently in place with health maintenance organizations and other general health plans. Physicians willing to partner with employers and other players in the workers' compensation arena currently face some challenging, rewarding, and exciting opportunities. In the immortal words of Hippocrates, "Healing is a matter of time, but it is sometimes a matter of opportunity."3 It is unclear whether Hippocrates ever imagined our current level of science, practice, and organization, but it is clear the opportunities to be an active participant in the changes occurring in workers' compensation are as real today as they were in 1973 when then President Nixon passed the Health Maintenance Organization Act.

Comprehensive management of pressure ulcers in spinal cord injury: Current concepts and future trends

PubMed Central

Kruger, Erwin A.; Pires, Marilyn; Ngann, Yvette; Sterling, Michelle; Rubayi, Salah

2013-01-01

Pressure ulcers in spinal cord injury represent a challenging problem for patients, their caregivers, and their physicians. They often lead to recurrent hospitalizations, multiple surgeries, and potentially devastating complications. They present a significant cost to the healthcare system, they require a multidisciplinary team approach to manage well, and outcomes directly depend on patients' education, prevention, and compliance with conservative and surgical protocols. With so many factors involved in the successful treatment of pressure ulcers, an update on their comprehensive management in spinal cord injury is warranted. Current concepts of local wound care, surgical options, as well as future trends from the latest wound healing research are reviewed to aid medical professionals in treating patients with this difficult problem. PMID:24090179

Current management of Parkinson's disease.

PubMed

Salawu, F; Olokoba, A; Danburam, A

2010-01-01

Although Parkinson's disease (PD) is still incurable, a large number of different treatments have become available to improve the quality of life and physical and psychological morbidity, and its early treatment is of prime importance. This article reviews the current situation of PD. This review was based on a search of Medline, the Cochrane Database of Systemic Reviews, and citation lists of relevant publications. The subject headings and keywords used were Parkinson's disease and therapeutic advances. Only articles written in English were included.The management of PD has evolved rapidly over the last 10 years with the advent of new drugs and new classes of drugs, but the currently available treatment methods are all symptomatic ones. However, some of these may have marginal disease-modifying effects. Progress in manufacture of newer drugs has markedly improved the treatment of early PD; however, the management of advanced Parkinson's symptoms remains a challenge. Currently no treatment has been proven to slow the progression of PD. Although symptomatic therapy can provide benefit for many years, PD will eventually result in significant morbidity.

Wealth from Health: an incentive program for disease and population management: a 12-year project.

PubMed

Ratner, D; Louria, D; Sheffet, A; Fain, R; Curran, J; Saed, N; Bhaskar, S; Quereshi, M; Cable, G

2001-01-01

The future of healthcare is linked with its ability to face the challenges of consumerism. Disease and population management will represent the dominant style of healthcare delivery in the future. This article describes the Wealth from Health programs which utilize current and future technologies to help the healthcare system become a leader in healthcare delivery and to assist many communities at an affordable cost.

Forging an Indian Partnership

DTIC Science & Technology

2012-01-01

significant poverty, it has the advantage of a vast supply of young workers, and its growth is largely market driven as opposed to state managed , as in...China itself is experiencing a similar slowdown. India’s current challenges to curb high inflation, improve its substandard infrastructure, manage ...re­ pression. During this time, China supplied Myanmar with roughly $1.2 billion in arms and has continued to jointly develop and operate radar and

Intelligent Transportation Systems (ITS) in the NPS : 2005 baseline inventory and preliminary program assessment

DOT National Transportation Integrated Search

2006-01-19

This report presents the current status of Intelligent Transportation Systems (ITS) within the 398 national parks managed by the National Park Service (NPS), discusses the potential of ITS to address the often unique transportation challenges faced b...

A historical perspective with current opinion on the management of atrophic mandibular fractures.

PubMed

Castro-Núñez, Jaime; Cunningham, Larry L; Van Sickels, Joseph E

2017-12-01

The management of atrophic mandibular fractures has been a challenge for maxillofacial surgeons for decades. During the past 70 years, various techniques for treating edentulous mandibular fractures have been advocated. These techniques have been praised, criticized, abandoned, improved, and used in combination with other methods. Although some of the principles of management outlined before the end of World War II are still valid in today's technological era, other concepts did not survive the test of time. The aim of this paper is to examine the evolution of treatment modalities for the management of atrophic mandibular fractures that have been employed over the years. Debates and discussions generated by this topic are included. Current techniques and treatment philosophies with thoughts for future therapies are provided. Copyright © 2017 Elsevier Inc. All rights reserved.

Current Concepts in Treatment of Patellofemoral Osteochondritis Dissecans

PubMed Central

Paine, Russ; Chicas, Eric; Gardner, Emily; Bailey, Lane; McDermott, James

2016-01-01

Identification, protection, and management of patellofemoral articular cartilage lesions continue to remain on the forefront of sports medicine rehabilitation. Due to high-level compression forces that are applied through the patellofemoral (PF) joint, managing articular cartilage lesions is challenging for sports medicine specialists. Articular cartilage damage may exist in a wide spectrum of injuries ranging from small, single areas of focal damage to wide spread osteoarthritis involving large chondral regions. Management of these conditions has evolved over the last two centuries, most recently using biogenetic materials and cartilage replacement modalities. The purpose of this clinical commentary is to discuss PF articular cartilage injuries, etiological variables, and investigate the evolution in management of articular cartilage lesions. Rehabilitation of these lesions will also be discussed with a focus on current trends and return to function criteria. Level of Evidence 5 PMID:27904793

Opportunities and challenges of cloud computing to improve health care services.

PubMed

Kuo, Alex Mu-Hsing

2011-09-21

Cloud computing is a new way of delivering computing resources and services. Many managers and experts believe that it can improve health care services, benefit health care research, and change the face of health information technology. However, as with any innovation, cloud computing should be rigorously evaluated before its widespread adoption. This paper discusses the concept and its current place in health care, and uses 4 aspects (management, technology, security, and legal) to evaluate the opportunities and challenges of this computing model. Strategic planning that could be used by a health organization to determine its direction, strategy, and resource allocation when it has decided to migrate from traditional to cloud-based health services is also discussed.

Near-infrared fluorescent nanoprobes for cancer molecular imaging: status and challenges

PubMed Central

He, Xiaoxiao; Gao, Jinhao; Gambhir, Sanjiv Sam; Cheng, Zhen

2010-01-01

Near-infrared fluorescence (NIRF) imaging promises to improve cancer imaging and management; advances in nanomaterials allow scientists to combine new nanoparticles with NIRF imaging techniques, thereby fulfilling this promise. Here, we present a synopsis of current developments in NIRF nanoprobes, their use in imaging small living subjects, their pharmacokinetics and toxicity and finally their integration into multimodal imaging strategies. We also discuss challenges impeding the clinical translation of NIRF nanoprobes for molecular imaging of cancer. Whereas utilization of most NIRF nanoprobes remains at a proof-of-principle stage, optimizing the impact of nanomedicine in cancer patient diagnosis and management will likely be realized through persistent interdisciplinary amalgamation of diverse research fields. PMID:20870460

Helicopter winchmens' experiences with pain management in challenging environments.

PubMed

van der Velde, J; Linehan, L; Cusack, S

2013-02-01

We conducted a survey of Irish Coast Guard Search and Rescue Helicopter winchmen to establish if their pain management scope of practice was adequate for their working environment. We surveyed 17 SAR personnel. 88% of winchmen have experienced scenarios where they were unable to reduce pain scores below 6/10. In seeking solutions within current Irish Prehospital Clinical Practice Guidelines, repeated descriptions of operations in extreme weather and sea conditions were given which were entirely incompatible with the dexterity required to break a glass ampoule and draw up solution, let alone site an intravenous (IV) line or administer a drug via intramuscular (IM) injection. Irish Coast Guard Search and Rescue Helicopter winchmen encounter polytrauma patients in extreme pain in uniquely challenging environments. Novel solutions to pain management within this tightly governed system are urgently required.

Recurrent Clostridium difficile Infection: From Colonization to Cure

PubMed Central

Shields, Kelsey; Araujo-Castillo, Roger V.; Theethira, Thimmaiah G.; Alonso, Carolyn D.; Kelly, Ciaran

2015-01-01

Clostridium difficile infection (CDI) is increasingly prevalent, dangerous and challenging to prevent and manage. Despite intense national and international attention the incidence of primary and of recurrent CDI (PCDI and RCDI, respectively) have risen rapidly throughout the past decade. Of major concern is the increase in cases of RCDI resulting in substantial morbidity, morality and economic burden. RCDI management remains challenging as there is no uniformly effective therapy, no firm consensus on optimal treatment, and reliable data regarding RCDI-specific treatment options is scant. Novel therapeutic strategies are critically needed to rapidly, accurately, and effectively identify and treat patients with, or at-risk for, RCDI. In this review we consider the factors implicated in the epidemiology, pathogenesis and clinical presentation of RCDI, evaluate current management options for RCDI and explore novel and emerging therapies. PMID:25930686

Rethinking 'risk' and self-management for chronic illness.

PubMed

Morden, Andrew; Jinks, Clare; Ong, Bie Nio

2012-02-01

Self-management for chronic illness is a current high profile UK healthcare policy. Policy and clinical recommendations relating to chronic illnesses are framed within a language of lifestyle risk management. This article argues the enactment of risk within current UK self-management policy is intimately related to neo-liberal ideology and is geared towards population governance. The approach that dominates policy perspectives to 'risk' management is critiqued for positioning people as rational subjects who calculate risk probabilities and act upon them. Furthermore this perspective fails to understand the lay person's construction and enactment of risk, their agenda and contextual needs when living with chronic illness. Of everyday relevance to lay people is the management of risk and uncertainty relating to social roles and obligations, the emotions involved when encountering the risk and uncertainty in chronic illness, and the challenges posed by social structural factors and social environments that have to be managed. Thus, clinical enactments of self-management policy would benefit from taking a more holistic view to patient need and seek to avoid solely communicating lifestyle risk factors to be self-managed.

The profile of diabetes healthcare professionals in Indonesia: a scoping review.

PubMed

Ligita, T; Wicking, K; Harvey, N; Mills, J

2018-01-10

To explore and synthesize evidence of the literature about healthcare professionals involved in the provision of diabetes management within an Indonesian context. Indonesia is challenged to control the major burden of diabetes prevalence rate that requires a multidimensional approach with the aim to optimize existing health services by involving healthcare professionals who can promote access and provide diabetes management. This literature review, which is integrated with a scoping study framework, used the electronic databases including CINAHL, PubMed, Scopus and Web of Science to locate papers particular to the Indonesian context. From the total of 568 papers found, 20 papers were selected. The literature review identified physicians, nurses, pharmacists, dieticians and diabetes educators as the providers of diabetes care and management in Indonesia. Collaborative management involving either interdisciplinary or intradisciplinary teams was mentioned in several papers. Internal challenges included limited skills and knowledge. External challenges included high patient volumes; a shortage of healthcare professionals and reduced funding. Overcoming the challenges cannot be undertaken with a workforce dominated by any one single healthcare professional. Coordinating with the government to improve the implementation of different roles in diabetes management will improve patient outcomes and thus reduce the burden of diabetes. Health policy reform should support nurses and other healthcare professionals in their professional development at all levels of health care. Policy makers can use the review findings to modify the current healthcare system to address key issues in workforce development; funding for services and medications; and fostering multidisciplinary care for diabetes management. © 2018 International Council of Nurses.

E-waste: a problem or an opportunity? Review of issues, challenges and solutions in Asian countries.

PubMed

Herat, Sunil; Agamuthu, P

2012-11-01

Safe management of electronic and electrical waste (e-waste/WEEE) is becoming a major problem for many countries around the world. In particular, developing countries face a number of issues with the generation, transboundary movement and management of e-waste. It is estimated that the world generates around 20-50 million tonnes of e-waste annually, most of it from Asian countries. Improper handling of e-waste can cause harm to the environment and human health because of its toxic components. Several countries around the world are now struggling to deal with this emerging threat. Although the current emphasis is on end-of-life management of e-waste activities, such as reuse, servicing, remanufacturing, recycling and disposal, upstream reduction of e-waste generation through green design and cleaner production is gaining much attention. Environmentally sound management (ESM) of e-waste in developing countries is absent or very limited. Transboundary movement of e-waste is a major issue throughout the region. Dealing with the informal recycling sector is a complex social and environmental issue. There are significant numbers of such challenges faced by these countries in achieving ESM of e-waste. This article aims to present a review of challenges and issues faced by Asian countries in managing their e-waste in a sustainable way.

Special Report: E-Waste Management in the United States and Public Health Implications.

PubMed

Seeberger, Jessica; Grandhi, Radhika; Kim, Stephani S; Mase, William A; Reponen, Tiina; Ho, Shuk-mei; Chen, Aimin

2016-10-01

Electronic waste (e-waste) generation is increasing worldwide, and its management becomes a significant challenge because of the many toxicants present in electronic devices. The U.S. is a major producer of e-waste, although its management practice and policy regulation are not sufficient to meet the challenge. We reviewed e-waste generation, current management practices and trends, policy challenges, potential health impact, and toxicant exposure prevention in the U.S. A large amount of toxic metals, flame retardants, and other persistent organic pollutants exist in e-waste or can be released from the disposal of e-waste (e.g., landfill, incineration, recycling). Landfill is still a major method used to dispose of obsolete electronic devices, and only about half of the states have initiated a landfill ban for e-waste. Recycling of e-waste is an increasing trend in the past few years. There is potential, however, for workers to be exposed to a mixture of toxicants in e-waste and these exposures should be curtailed. Perspectives and recommendations are provided regarding managing e-waste in the U.S. to protect public health, including enacting federal legislation, discontinuing landfill disposal, protecting workers in recycling facilities from toxicant exposure, reducing toxicant release into the environment, and raising awareness of this growing environmental health issue among the public.

Challenges and opportunities associated with waste management in India

PubMed Central

Kumar, Sunil; Smith, Stephen R.; Fowler, Geoff; Velis, Costas; Kumar, S. Jyoti; Arya, Shashi; Rena; Kumar, Rakesh

2017-01-01

India faces major environmental challenges associated with waste generation and inadequate waste collection, transport, treatment and disposal. Current systems in India cannot cope with the volumes of waste generated by an increasing urban population, and this impacts on the environment and public health. The challenges and barriers are significant, but so are the opportunities. This paper reports on an international seminar on ‘Sustainable solid waste management for cities: opportunities in South Asian Association for Regional Cooperation (SAARC) countries’ organized by the Council of Scientific and Industrial Research-National Environmental Engineering Research Institute and the Royal Society. A priority is to move from reliance on waste dumps that offer no environmental protection, to waste management systems that retain useful resources within the economy. Waste segregation at source and use of specialized waste processing facilities to separate recyclable materials has a key role. Disposal of residual waste after extraction of material resources needs engineered landfill sites and/or investment in waste-to-energy facilities. The potential for energy generation from landfill via methane extraction or thermal treatment is a major opportunity, but a key barrier is the shortage of qualified engineers and environmental professionals with the experience to deliver improved waste management systems in India. PMID:28405362

Sustainability and the health care manager: part I.

PubMed

Ramirez, Bernardo; Oetjen, Reid M; Malvey, Donna

2011-01-01

Given the current operating climate, organizations are coming under pressure to develop and implement sustainability programs and projects, yet few managers truly understand what is meant by sustainability and its implications for managing organizations. This article examines the concept of sustainability and provides a broader definition of the term than going "green." Using a puzzle metaphor, the authors outline and explain the different components of sustainability and provide a checklist for achieving sustainability goals. In addition, resources such as guides and tools are reviewed and offered to assist managers in gaining more insight into the challenges and complexity of sustainability.

Managing Weight: What Do People with an Intellectual Disability Want from Mobile Technology?

PubMed

Smyth, Phil; McDowell, Claire; Leslie, Julian C; Leader, Geraldine; Donnelly, Mark; Simpson, Elizabeth; Skelly, Laura

2017-01-01

Obesity is a significant health challenge. People with Intellectual Disability (ID) are particularly vulnerable to developing obesity. Mobile technology has been developed to support the management of weight and obesity in the form of apps, although not with people with an ID in mind. As a result existing off-the-shelf weight management apps currently available may not be functional in supporting weight reduction within this population. This paper presents the results of consultations with people with ID regarding weight management, comfort with mobile technology and desired characteristics in apps designed for people with ID that target weight management.

Non-invasive diagnostic platforms in management of non-small cell lung cancer: opportunities and challenges

PubMed Central

Pennell, Nathan A.

2017-01-01

Several non-invasive diagnostic platforms are already being incorporated in routine clinical practice in the work up and monitoring of patients with lung cancer. These approaches have great potential to improve patient selection and monitor patients while on therapy, however several challenges exist in clinical validation and standardization of such platforms. In this review, we summarize the current technologies available for non-invasive diagnostic evaluation from the blood of patients with non-small cell lung cancer (NSCLC), and discuss the technical and logistical challenges associated incorporating such testing in clinical practice. PMID:29057238

Integrating management tools and concepts to develop an estuarine planning support system: A case study of the Humber Estuary, Eastern England.

PubMed

Lonsdale, Jemma-Anne; Weston, Keith; Barnard, Steve; Boyes, Suzanne J; Elliott, Michael

2015-11-15

Estuaries are important because of their multiple uses and users which often makes them challenging to manage since management must strike a balance between the needs of users, the estuaries' ecological and economic value and the context of multiple legislative drivers. To facilitate management we have therefore developed an Estuarine Planning Support System (EPSS) framework using the Humber Estuary, Eastern England, as a case study which integrates the current legislation tools and concepts. This integrated EPSS framework is an improvement on previous approaches for assessing cumulative impacts as it takes into account legislative drivers, management tools and other mechanisms for controlling plans/projects specific to the estuary. It therefore enables managers and users to assess and address both the current state and the way in which a new industrial, port or urban development could impact an estuary in an accessible and understandable framework. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Partnering with patients to promote holistic diabetes management: changing paradigms.

PubMed

Lorenzo, Lenora

2013-07-01

To provide a review of best practice for clinical management of diabetes mellitus (DM) for nurse practitioners (NPs) and accelerate incorporation of key findings into current practice. A search was conducted in Pub Med, Ovid, CINAHL, and Cochrane's Database of Systematic Reviews. There are many challenges for DM care identified in the current health system. There is a great need to change care paradigms to engage patients in partnership for enhanced management and self-management in DM. A review of the best practice evidence revealed numerous models of care, strategies, and tools available to enhance diabetes care and promote health and well-being. The primary focus of this article is to engage NP clinicians to incorporate new strategies to augment management and improve clinical outcomes. Incorporation of best practice for DM management may accelerate the paradigm shift to more patient-focused care. Engaged, informed, and activated patients along with clinicians working in partnerships may enhance clinical outcomes. ©2013 The Author ©2013 American Association of Nurse Practitioners.

21st Century Water Asset Accounting - Case Studies Report (WERF Report INFR6R12a)

EPA Science Inventory

America’s decaying water infrastructure presents significant financial and logistical challenges for water utilities. Green infrastructure has been gaining traction as a viable alternative and complement to traditional “grey” infrastructure for water management. Current accounti...

EU Water Governance: Striking the Right Balance between Regulatory Flexibility and Enforcement?

EPA Science Inventory

Considering the challenges and threats currently facing water management and the exacerbation of uncertainty by climate change, the need for flexible yet robust and legitimate environmental regulation is evident. The European Union took a novel approach toward sustainable water r...

Leadership Theories--Managing Practices, Challenges, Suggestions

ERIC Educational Resources Information Center

Hawkins, Cheryl

2009-01-01

A shortage of community college executives due to the number of retirements occurring among current leaders is predicted. An examination of three leadership theories--servant-leadership, business leadership and transformational leadership--suggests techniques for potential community college leaders. Servant-leaders focus on the needs of their…

Integrative approaches: promoting socioecological resilience

Treesearch

J.W. Long; Carl Skinner; M. North; C.T. Hunsaker; L. Quinn-Davidson

2014-01-01

This chapter begins by discussing current challenges for ecosystem management that emerged from multiple chapters of the full synthesis. It then considers integrative approaches to promote resilience, including general strategies that recognize the integrated nature of socioecological systems, the importance of promoting disturbance regimes upon which these systems...

Topics in Finance. Part V--Capital Structure

ERIC Educational Resources Information Center

Laux, Judy

2011-01-01

Continuing this series on the theory of financial management, the current article investigates capital structure, offering insight into the roles of stockholder wealth maximization, the risk-return tradeoff, and agency conflicts. Much literature addresses this topic, and some of the most recent literature challenges certain theoretical…

Librarians' Attitudes toward Knowledge Management

ERIC Educational Resources Information Center

Aharony, Noa

2011-01-01

The purpose of this research is to develop an understanding of the factors that support or constrain the individual's sharing knowledge in the organization. The current study seeks to explore whether personality (self-efficacy and self-esteem) and situational (cognitive appraisal: threat versus challenge) characteristics influence participants'…

State of the art evaluation of traffic detection and monitoring systems. Volume 1, phases A & B : design [Summary

DOT National Transportation Integrated Search

2007-10-01

Accurate, complete, and timely traffic data is critical to the effective management of Arizonas highway system. Limitations in current traffic monitoring abilities are an ongoing challenge for the Arizona Department of Transportation (ADOT) and fo...

78 FR 67349 - Revision of a Currently Approved Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-12

... submitted to the Office of Management and Budget (OMB) for clearance, a proposal for collection of... to report the progress of participants in the DOE Better Buildings programs, including the Better Buildings Challenge, Better Buildings, Better Plants program, and the Better Buildings Alliance. These...

Psychological treatments in intellectual disability: the challenges of building a good evidence base.

PubMed

Bhaumik, Sabyasachi; Gangadharan, Satheesh; Hiremath, Avinash; Russell, Paul Swamidhas Sudhakar

2011-06-01

Psychological treatments are widely used for the management of mental health and behavioural problems in people with intellectual disabilities. The evidence base, including the cost-effectiveness of such interventions, is limited. This editorial explores the current evidence base and analyses its strengths and limitations. The editorial also highlights current problems in conducting randomised controlled trials in this area and suggests a way forward.

Is There Any Point in Wearing Dead Men's Spectacles? How the Theoretical Insights of Adler and Colleagues Relate to Current Practice with Children Experiencing EBD

ERIC Educational Resources Information Center

Blamires, Mike

2006-01-01

This article explores the legacy of Adlerian approaches to behaviour. Mike Blamires offers an opportunity to consider the impact of Adler's premise that education is fundamentally about encouragement and the promotion of democratic principles. In so doing he challenges us to interrogate the term "behaviour management", and its current use by…

MO-B-201-01: Overcoming the Challenges of Motion Management in Current Lung SBRT Practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shang, C.

The motion management in stereotactic body radiation therapy (SBRT) is a key to success for a SBRT program, and still an on-going challenging task. A major factor is that moving structures behave differently than standing structures when examined by imaging modalities, and thus require special considerations and employments. Understanding the motion effects to these different imaging processes is a prerequisite for a decent motion management program. The commonly used motion control techniques to physically restrict tumor motion, if adopted correctly, effectively increase the conformity and accuracy of hypofractionated treatment. The effective application of such requires one to understand the mechanicsmore » of the application and the related physiology especially related to respiration. The image-guided radiation beam control, or tumor tracking, further realized the endeavor for precision-targeting. During tumor tracking, the respiratory motion is often constantly monitored by non-ionizing beam sources using the body surface as its surrogate. This then has to synchronize with the actual internal tumor motion. The latter is often accomplished by stereo X-ray imaging or similar techniques. With these advanced technologies, one may drastically reduce the treated volume and increase the clinicians’ confidence for a high fractional ablative radiation dose. However, the challenges in implementing the motion management may not be trivial and is dependent on each clinic case. This session of presentations is intended to provide an overview of the current techniques used in managing the tumor motion in SBRT, specifically for routine lung SBRT, proton based treatments, and newly-developed MR guided RT. Learning Objectives: Through this presentation, the audience will understand basic roles of commonly used imaging modalities for lung cancer studies; familiarize the major advantages and limitations of each discussed motion control methods; familiarize the major advantages and limitations of each discussed radiation beam control methodology and tumor tacking method; understand the key points in motion management for a high quality SBRT program.« less

Archiving strategy for USGS EROS center and our future direction

USGS Publications Warehouse

Faundeen, John L.

2010-01-01

The U. S. Geological Survey's Earth Resources Observation and Science Center has the responsibility to acquire, manage, and preserve our Nation's land observations. These records are obtained primarily from airplanes and satellites dating back to the 1930s. The ability to compare landscapes from the past with current information enables change analysis at local and global scales. With new observations added daily, the records management challenges are daunting, involving petabytes of electronic data and tens of thousands of rolls of analog film. This paper focuses upon the appraisal and preservation functions employed to ensure that these records are available for current and future generations.

The integrated rangeland fire management strategy actionable science plan

USGS Publications Warehouse

Aldridge, Cameron L.; Berg, Ken; Boyd, Chad S.; Boyte, Stephen P.; Bradford, John B.; Brunson, Ed; Cissel, John H.; Conway, Courtney J.; Chalfoun, Anna D.; Chambers, Jeanne C.; Clark, Patrick; Coates, Peter S.; Crist, Michele R.; Davis, Dawn M.; DeCrappeo, Nicole; Deibert, Patricia A.; Doherty, Kevin E.; Evers, Louisa B.; Finch, Deborah M.; Finn, Sean P.; Germino, Matthew J.; Glenn, Nancy F.; Gucker, Corey; Hall, John A.; Hanser, Steven E.; Havlina, Douglas W.; Heinrichs, Julie; Heller, Matt; Homer, Collin G.; Hunter, Molly E.; Jacobs, Ruth W.; Karl, Jason W.; Kearney, Richard; Kemp, Susan K; Kilkenny, Francis F.; Knick, Steven T.; Launchbaugh, Karen; Manier, Daniel J.; Mayer, Kenneth E.; Meyer, Susan E.; Monroe, Adrian; MontBlanc, Eugénie; Newingham, Beth A.; Pellant, Michael L.; Phillips, Susan L.; Pilliod, David S.; Ricca, Mark A.; Richardson, Bryce A.; Rose, Jeffrey A.; Shaw, Nancy; Sheley, Roger L.; Shinneman, Douglas J.; Wiechman , Lief A.; Wylie, Bruce K.

2016-01-01

The Integrated Rangeland Fire Management Strategy (hereafter Strategy, DOI 2015) outlined the need for coordinated, science-based adaptive management to achieve long-term protection, conservation, and restoration of the sagebrush (Artemisia spp.) ecosystem. A key component of this management approach is the identification of knowledge gaps that limit implementation of effective strategies to meet current management challenges. The tasks and actions identified in the Strategy address several broad topics related to management of the sagebrush ecosystem. This science plan is organized around these topics and specifically focuses on fire, invasive plant species and their effects on altering fire regimes, restoration, sagebrush and greater sage-grouse (Centrocercus urophasianus), and climate and weather.

Towards a Tool for Malaria Supply Chain Management Improvement in Rural Ghana.

PubMed

Carlo, Lorena; Bakken, Suzanne; Mamykina, Lena; Kodie, Richmond; Kanter, Andrew S

2015-01-01

The maintenance of adequate quantities of antimalarial medicines and rapid diagnostic tests (RDTs) at health facilities in rural areas of sub-Saharan Africa is a challenging task because of poor supply chain management. Antimalarial stock-outs in the communities could lead patients (that need to travel long distances to get medications) to remain untreated, develop severe malaria and die. A prototype to improve the management of health commodities in rural Ghana through the visualization of current stock levels and the forecasting of commodities is proposed.

Metformin, oral contraceptives or both to manage oligo-amenorrhea in adolescents with polycystic ovary syndrome? A clinical review.

PubMed

Palomba, Stefano; Materazzo, Caterina; Falbo, Angela; Orio, Francesco; La Sala, Giovanni Battista; Sultan, Charles

2014-05-01

The management of oligo-amenorrhea in adolescent patients with polycystic ovary syndrome (PCOS) represents an important and difficult challenge. Metformin and/or oral contraceptives (OCs) are different strategies widely proposed in these patients. The objective of the current review was to provide an overview on the use of metformin and/or OCs for the management of oligo-amenorrhea in adolescents with PCOS underlining their potential risks and benefits in order to help the clinician to choose the best patients' tailored treatment.

Management strategies for persistent epithelial defects of the cornea

PubMed Central

Katzman, Lee R.; Jeng, Bennie H.

2014-01-01

Management of patients with persistent epithelial defects of the cornea can be challenging to even the seasoned ophthalmologist. It is essential that one understands not only the pathophysiology of the failure of the epithelium to migrate and close a wound appropriately, but also the mechanism of action of the available treatment modalities at one’s disposal. This article serves as a review of current standard therapies, recently introduced alternative therapies gaining in popularity, and a look into the newest developments that may change the way we manage corneal surface disease. PMID:25278792

[Management of Patients on Antithrombotic Agents Undergoing Endoscopy].

PubMed

Kim, Joon Sung; Kim, Byung Wook

2018-05-25

Antithrombotic agents are used increasingly in Asia. The management of patients on antithrombotics undergoing elective or emergency endoscopy has become an increasing clinical challenge for gastroenterologists. Current practice guidelines have been developed by societies from western countries. On the other hand, these guidelines cannot meet the specific needs of the Asian Pacific region, raising the need for separate guidelines in Asia. This review compares the recommendations of previous guidelines with the most recently published Asian guidelines regarding the management of patients on antithrombotic agents undergoing elective and emergency endoscopy.

SKA Telescope Manager (TM): status and architecture overview

NASA Astrophysics Data System (ADS)

Natarajan, Swaminathan; Barbosa, Domingos; Barraca, Joao P.; Bridger, Alan; Choudhury, Subhrojyoti R.; Di Carlo, Matteo; Dolci, Mauro; Gupta, Yashwant; Guzman, Juan; Van den Heever, Lize; Le Roux, Gerhard; Nicol, Mark; Patil, Mangesh; Smareglia, Riccardo; Swart, Paul; Thompson, Roger; Vrcic, Sonja; Williams, Stewart

2016-07-01

The SKA radio telescope project is building two telescopes, SKA-Low in Australia and SKA-Mid in South Africa respectively. The Telescope Manager is responsible for the observations lifecycle and for monitoring and control of each instrument, and is being developed by an international consortium. The project is currently in the design phase, with the Preliminary Design Review having been successfully completed, along with re-baselining to match project scope to available budget. This report presents the status of the Telescope Manager work, key architectural challenges and our approach to addressing them.

Sources and sinks of carbon in boreal ecosystems of interior Alaska: a review

USGS Publications Warehouse

Douglas, Thomas A.; Jones, Miriam C.; Hiemstra, Christopher A.

2014-01-01

Boreal regions store large quantities of carbon but are increasingly vulnerable to carbon loss due to disturbance and climate warming. The boreal region, underlain by discontinuous permafrost, presents a challenging landscape for itemizing current and potential carbon sources and sinks in the boreal soil and vegetation. The roles of fire, forest succession, and the presence (or absence) of permafrost on carbon cycle, vegetation, and hydrologic processes have been the focus of multidisciplinary research in this area for the past 20 years. However, projections of a warming future climate, an increase in fire severity and extent, and the potential degradation of permafrost could lead to major landscape process changes over the next 20 to 50 years. This provides a major challenge for predicting how the interplay between land management activities and impacts of climate warming will affect carbon sources and sinks in Interior Alaska. To assist land managers in adapting and managing for potential changes in the Interior Alaska carbon cycle we developed this review paper incorporating an overview of the climate, ecosystem processes, vegetation types, and soil regimes in Interior Alaska with a focus on ramifications for the carbon cycle. Our objective is to provide a synthesis of the most current carbon storage estimates and measurements to support policy and land management decisions on how to best manage carbon sources and sinks in Interior Alaska. To support this we have surveyed relevant peer reviewed estimates of carbon stocks in aboveground and belowground biomass for Interior Alaska boreal ecosystems. We have also summarized methane and carbon dioxide fluxes from the same ecosystems. These data have been converted into the same units to facilitate comparison across ecosystem compartments. We identify potential changes in the carbon cycle with climate change and human disturbance including how compounding disturbances can affect the boreal system. Finally, we provide recommendations to address the challenges facing land managers in efforts to manage carbon cycle processes. The results of this study can be used for carbon cycle management in other locations within the boreal biome which encompass a broad distribution from 45° to 83° north.

Will a catch share for whales improve social welfare?

PubMed

Smith, Martin D; Asche, Frank; Bennear, Lori S; Havice, Elizabeth; Read, Andrew J; Squires, Dale

2014-01-01

We critique a proposal to use catch shares to manage transboundary wildlife resources with potentially high non-extractive values, and we focus on the case of whales. Because whales are impure public goods, a policy that fails to capture all nonmarket benefits (due to free riding) could lead to a suboptimal outcome. Even if free riding were overcome, whale shares would face four implementation challenges. First, a whale share could legitimize the international trade in whale meat and expand the whale meat market. Second, a legal whale trade creates monitoring and enforcement challenges similar to those of organizations that manage highly migratory species such as tuna. Third, a whale share could create a new political economy of management that changes incentives and increases costs for nongovernmental organizations (NGOs) to achieve the current level of conservation. Fourth, a whale share program creates new logistical challenges for quota definition and allocation regardless of whether the market for whale products expands or contracts. Each of these issues, if left unaddressed, could result in lower overall welfare for society than under the status quo.

An Overview of the Challenges With and Proposed Solutions for the Ingest and Distribution Processes for Airborne Data Management

NASA Technical Reports Server (NTRS)

Beach, Aubrey; Northup, Emily; Early, Amanda; Wang, Dali; Kusterer, John; Quam, Brandi; Chen, Gao

2015-01-01

The current data management practices for NASA airborne field projects have successfully served science team data needs over the past 30 years to achieve project science objectives, however, users have discovered a number of issues in terms of data reporting and format. The ICARTT format, a NASA standard since 2010, is currently the most popular among the airborne measurement community. Although easy for humans to use, the format standard is not sufficiently rigorous to be machine-readable. This makes data use and management tedious and resource intensive, and also create problems in Distributed Active Archive Center (DAAC) data ingest procedures and distribution. Further, most DAACs use metadata models that concentrate on satellite data observations, making them less prepared to deal with airborne data.

Informatics in clinical research in oncology: current state, challenges, and a future perspective.

PubMed

Chahal, Amar P S

2011-01-01

The informatics landscape of clinical trials in oncology has changed significantly in the last 10 years. The current state of the infrastructure for clinical trial management, execution, and data management is reviewed. The systems, their functionality, the users, and the standards available to researchers are discussed from the perspective of the oncologist-researcher. Challenges in complexity and in the processing of information are outlined. These challenges include the lack of communication and information-interchange between systems, the lack of simplified standards, and the lack of implementation and adherence to the standards that are available. The clinical toxicology criteria from the National Cancer Institute (CTCAE) are cited as a successful standard in oncology, and HTTP on the Internet is referenced for its simplicity. Differences in the management of information standards between industries are discussed. Possible future advances in oncology clinical research informatics are addressed. These advances include strategic policy review of standards and the implementation of actions to make standards free, ubiquitous, simple, and easily interpretable; the need to change from a local data-capture- or transaction-driven model to a large-scale data-interpretation model that provides higher value to the oncologist and the patient; and the need for information technology investment in a readily available digital educational model for clinical research in oncology that is customizable for individual studies. These new approaches, with changes in information delivery to mobile platforms, will set the stage for the next decade in clinical research informatics.

Employing Earned Value Management in Government Research and Design - Lessons Learned from the Trenches

NASA Technical Reports Server (NTRS)

Simon, Tom

2009-01-01

To effectively manage a project, the project manager must have a plan, understand the current conditions, and be able to take action to correct the course when challenges arise. Research and design projects face technical, schedule, and budget challenges that make it difficult to utilize project management tools developed for projects based on previously demonstrated technologies. Projects developing new technologies by their inherent nature are trying something new and thus have little to no data to support estimates for schedule and cost, let alone the technical outcome. Projects with a vision for the outcome but little confidence in the exact tasks to accomplish in order to achieve the vision incur cost and schedule penalties when conceptual solutions require unexpected iterations or even a reinvention of the plan. This presentation will share the project management methodology and tools developed through trial and error for a NASA research and design project combining industry, academia, and NASA inhouse work in which Earned Value Management principles were employed but adapted for the reality of the government financial system and the reality of challenging technology development. The priorities of the presented methodology are flexibility, accountability, and simplicity to give the manager tools to help deliver to the customer while not using up valuable time and resources on extensive planning and analysis. This presentation will share the methodology, tools, and work through failed and successful examples from the three years of process evolution.

Coping with Computing Success.

ERIC Educational Resources Information Center

Breslin, Richard D.

Elements of computing success of Iona College, the challenges it currently faces, and the strategies conceived to cope with future computing needs are discussed. The college has mandated computer literacy for students and offers nine degrees in the computerized information system/management information system areas. Since planning is needed in…

On Moral Education through Deliberative Communication

ERIC Educational Resources Information Center

Englund, Tomas

2016-01-01

John Dewey's masterpiece "Democracy and Education", from 1916, is clearly far removed from the dominant tendencies of current education policy in the western world, with their emphasis on the narrow accountability of the New Public Management. Nevertheless, his book still challenges those tendencies and sets forth criteria for…

Control of pestivirus infections in the management of wildlife populations

USDA-ARS?s Scientific Manuscript database

The lack of host-specificity allow pestiviruses to infect domestic livestock as well as captive and free-ranging wildlife, posing unique challenges to different stakeholders. While current control measures for bovine viral diarrhea virus (BVDV) are focused only on cattle, increased attention on the ...

Topics in Finance: Part VIII--Mergers & Acquisitions

ERIC Educational Resources Information Center

Laux, Judy

2012-01-01

In this series, three key axioms--stockholder wealth maximization, the risk-return tradeoff, and agency conflicts--are applied to the major topics in financial management. The current article looks at mergers and acquisitions, reviewing the presumed motivations, the ethical challenges, and the literature dedicated to this financial activity.

Resource Management and Financial Equilibrium.

ERIC Educational Resources Information Center

Massy, William F.

1975-01-01

The critical importance of planning in higher education is addressed. The challenge to planning is seen not just as alleviating the current pressures, but in assuring that the traditions of independence, creativity, and intellectual excellence survive. The planning process at Stanford University is described. For the university, the process of…

An Update on the Current Management of Perforated Diverticulitis.

PubMed

Zoog, Evon; Giles, W Heath; Maxwell, Robert A

2017-12-01

The management of perforated diverticulitis is a challenging aspect of general surgery. The prevalence of colonic diverticular disease has increased over the last decade and will continue to increase as the baby boomers add to the elderly population. Improvements in diagnostic imaging modalities, efforts to maintain intestinal continuity, and percutaneous drainage procedures now result in several alternatives when selecting a management strategy for complicated presentations. Specifically, laparoscopic lavage and resection with primary anastomosis have emerged as options for treatment of Hinchey III and IV diverticulitis in place of diversion in the appropriately selected patient. Percutaneous drainage of Hinchey II diverticulitis in centers equipped with interventional radiology provides another minimally invasive adjunct. The objective of this paper is to provide an update on the current management of perforated diverticulitis, with a focus on the advantages and disadvantages of the surgical options for the treatment of Hinchey III and IV diverticulitis.

Technology-based interventions for weight management: current randomized controlled trial evidence and future directions

PubMed Central

Buscemi, Joanna; Hawkins, Misty A. W.; Wang, Monica L.; Breland, Jessica Y.; Ross, Kathryn M.; Kommu, Anupama

2018-01-01

Obesity is a prevalent health care issue associated with disability, premature morality, and high costs. Behavioral weight management interventions lead to clinically significant weight losses in overweight and obese individuals; however, many individuals are not able to participate in these face-to-face treatments due to limited access, cost, and/or time constraints. Technological advances such as widespread access to the Internet, increased use of smartphones, and newer behavioral self-monitoring tools have resulted in the development of a variety of eHealth weight management programs. In the present paper, a summary of the most current literature is provided along with potential solutions to methodological challenges (e.g., high attrition, minimal participant racial/ethnic diversity, heterogeneity of technology delivery modes). Dissemination and policy implications will be highlighted as future directions for the field of eHealth weight management. PMID:27783259

Recent advances in managing idiopathic pulmonary fibrosis

PubMed Central

Scelfo, Chiara; Caminati, Antonella; Harari, Sergio

2017-01-01

Idiopathic pulmonary fibrosis (IPF) is a rare pulmonary disease with a poor prognosis and severe impact on quality of life. Early diagnosis is still challenging and important delays are registered before final diagnosis can be reached. Available tools fail to predict the variable course of the disease and to evaluate response to antifibrotic drugs. Despite the recent approval of pirfenidone and nintedanib, significant challenges remain to improve prognosis and quality of life. It is hoped that the new insights gained in pathobiology in the last few years will lead to further advances in the diagnosis and management of IPF. Currently, early diagnosis and prompt initiation of treatments reducing lung function loss offer the best hope for improved outcomes. This article aims at providing an overview of recent advances in managing patients with IPF and has a particular focus on how to reach a diagnosis, manage comorbidities and lung transplantation, care for the non-pharmacological needs of patients, and address palliative care. PMID:29225786

Pharmacy workforce to prevent and manage non-communicable diseases in developing nations: The case of Nepal.

PubMed

Khanal, Saval; Nissen, Lisa; Veerman, Lennert; Hollingworth, Samantha

2016-01-01

Non-communicable diseases (NCDs, e.g. cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus) are the main causes of mortality and morbidity in developing countries, including Nepal. Nearly half of the deaths in Nepal are caused by NCDs. Nepal lacks adequate human resources to prevent and manage NCDs, but the skills and expertise of pharmacists in Nepal are underused. There is evidence from many countries that pharmacists can contribute substantially to the prevention and management NCD. We aim to describe the opportunities and challenges for pharmacists to prevent and manage NCDs in Nepal. Pharmacists can contribute by screening and monitoring NCDs; counseling on lifestyle; providing medication therapy management services; promoting public health; and providing other pharmaceutical services. Challenges to the implementation of some of these activities in the current context include inadequate training of pharmacists in NCD prevention and management, the cost of pharmaceutical services to patients and government, and the existing health care service delivery model. There is a need for health services research to determine how pharmacists can be best used to prevent and manage NCDs in Nepal. Copyright © 2015 Elsevier Inc. All rights reserved.

[Questions concerning humanitarian action].

PubMed

Simonnot, C

2002-01-01

Although development of humanitarian action is rooted historical events, the dynamics behind today's international relief organizations can only be understood within the context of the modern world. Relief organizations are currently confronted with major challenges and paradoxes. The challenges include the need to enhance professionalization and standardization of assistance operations and exposure to greater risks. The paradoxes involve the need to implement complex, highly publicized programs in a simplistic manner and problems involved in managing the complex relationship between relief workers and victims, tainted with the almighty powers of the actors.

Cryptosporidiosis: Environmental, therapeutic, and preventive challenges

PubMed Central

Collinet-Adler, Stefan; Ward, Honorine D.

2014-01-01

Cryptosporidium spp. are responsible for endemic and epidemic disease worldwide. Clinical manifestations may include acute, persistent, or chronic diarrhea, biliary, and pulmonary disease. Disease severity ranges from asymptomatic or mild to severe, intractable diarrhea with wasting depending on immune status, nutrition, and age. Transmission is fecal-oral with both human and animal reservoirs. Disease is often self limited in healthy individuals, but therapy remains a challenge in the immune-compromised. Prevention currently depends on appropriate hygiene and proper water management and treatment. PMID:20521158

A Framework for Reliability and Safety Analysis of Complex Space Missions

NASA Technical Reports Server (NTRS)

Evans, John W.; Groen, Frank; Wang, Lui; Austin, Rebekah; Witulski, Art; Mahadevan, Nagabhushan; Cornford, Steven L.; Feather, Martin S.; Lindsey, Nancy

2017-01-01

Long duration and complex mission scenarios are characteristics of NASA's human exploration of Mars, and will provide unprecedented challenges. Systems reliability and safety will become increasingly demanding and management of uncertainty will be increasingly important. NASA's current pioneering strategy recognizes and relies upon assurance of crew and asset safety. In this regard, flexibility to develop and innovate in the emergence of new design environments and methodologies, encompassing modeling of complex systems, is essential to meet the challenges.

Medical management of epileptic seizures: challenges and solutions.

PubMed

Sarma, Anand K; Khandker, Nabil; Kurczewski, Lisa; Brophy, Gretchen M

2016-01-01

Epilepsy is one of the most common neurologic illnesses. This condition afflicts 2.9 million adults and children in the US, leading to an economic impact amounting to $15.5 billion. Despite the significant burden epilepsy places on the population, it is not very well understood. As this understanding continues to evolve, it is important for clinicians to stay up to date with the latest advances to provide the best care for patients. In the last 20 years, the US Food and Drug Administration has approved 15 new antiepileptic drugs (AEDs), with many more currently in development. Other advances have been achieved in terms of diagnostic modalities like electroencephalography technology, treatment devices like vagal nerve and deep-brain stimulators, novel alternate routes of drug administration, and improvement in surgical techniques. Specific patient populations, such as the pregnant, elderly, those with HIV/AIDS, and those with psychiatric illness, present their own unique challenges, with AED side effects, drug interactions, and medical-psychiatric comorbidities adding to the conundrum. The purpose of this article is to review the latest literature guiding the management of acute epileptic seizures, focusing on the current challenges across different practice settings, and it discusses studies in various patient populations, including the pregnant, geriatric, those with HIV/AIDS, comatose, psychiatric, and "pseudoseizure" patients, and offers possible evidence-based solutions or the expert opinion of the authors. Also included is information on newer AEDs, routes of administration, and significant AED-related drug-interaction tables. This review has tried to address only some of these issues that any practitioner who deals with the acute management of seizures may encounter. The document also highlights the numerous avenues for new research that would help practitioners optimize epilepsy management.

Innovative approaches to glaucoma management of Boston keratoprosthesis type 1.

PubMed

Vajaranant, Thasarat S; Liu, Jessica; Wilensky, Jacob; Cortina, M Soledad; Aref, Ahmad A

2016-09-01

Glaucoma remains a prevalent disorder and visual limiting factor after Boston keratoprosthesis type 1 implantation. Patients with glaucoma have worse initial and late visual acuity outcomes after otherwise successful keratoprosthesis implantation. Management of glaucoma in the setting of a keratoprosthesis is challenging because of relatively rapid progression and an inability to accurately measure intraocular pressure (IOP). In addition, there are no standard guidelines for glaucoma surveillance and monitoring after keratoprosthesis surgery. This report provides a review of the current literature and offers innovative strategies that will overcome the challenges in managing glaucoma in the setting of a Boston keratoprosthesis type 1 implant. The topics that will be discussed in this section include alternative methods for IOP measurement, rationales and surgical techniques for a pars plana tube placement for glaucoma drainage device, effective medical and laser treatment, the risk for IOP elevations after YAG laser, and practical guides to glaucoma surveillance and monitoring.

Aplastic anemia during pregnancy: a review of obstetric and anesthetic considerations

PubMed Central

Riveros-Perez, Efrain; Hermesch, Amy C; Barbour, Linda A; Hawkins, Joy L

2018-01-01

Aplastic anemia is a hematologic condition occasionally presenting during pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management is challenging, and treatment requires a coordinated effort by an interdisciplinary team, in order to provide safe care to these patients. In this review, we describe the current state of the literature as it applies to the complexity of aplastic anemia in pregnancy, focusing on pathophysiologic aspects of the disease in pregnancy, as well as relevant obstetric and anesthetic considerations necessary to treat this challenging problem. A multidisciplinary-team approach to the management of aplastic anemia in pregnancy is necessary to coordinate prenatal care, optimize maternofetal outcomes, and plan peripartum interventions. Conservative transfusion management is critical to prevent alloimmunization. Although a safe threshold-platelet count for neuraxial anesthesia has not been established, selection of anesthetic technique must be evaluated on a case-to-case basis. PMID:29535558

A biopsychosocial model for the management of patients with sickle-cell disease transitioning to adult medical care.

PubMed

Crosby, Lori E; Quinn, Charles T; Kalinyak, Karen A

2015-04-01

The lifespan of patients with sickle-cell disease (SCD) continues to increase, and most affected individuals in high-resource countries now live into adulthood. This necessitates a successful transition from pediatric to adult health care. Care for transitioning patients with SCD often falls to primary care providers who may not be fully aware of the many challenges and issues faced by patients and the current management strategies for SCD. In this review, we aim to close the knowledge gap between primary care providers and specialists who treat transitioning patients with SCD. We describe the challenges and issues encountered by these patients, and we propose a biopsychosocial multidisciplinary approach to the management of the identified issues. Examples of this approach, such as transition-focused integrated care models and quality improvement collaboratives, with the potential to improve health outcomes in adulthood are also described.

Foundational Report Series: Advanced Distribution Management Systems for Grid Modernization, DMS Industry Survey

DOE Office of Scientific and Technical Information (OSTI.GOV)

Singh, Ravindra; Uluski, Robert; Reilly, James T.

The objective of this survey is to benchmark current practices for DMS implementation to serve as a guide for future system implementations. The survey sought information on current plans to implement DMS, DMS functions of interest, implementation challenges, functional benefits achieved, and other relevant information. These survey results were combined (where possible) with results of similar surveys conducted in the previous four years to observe trends over time.

Opportunities and Challenges of Cloud Computing to Improve Health Care Services

PubMed Central

2011-01-01

Cloud computing is a new way of delivering computing resources and services. Many managers and experts believe that it can improve health care services, benefit health care research, and change the face of health information technology. However, as with any innovation, cloud computing should be rigorously evaluated before its widespread adoption. This paper discusses the concept and its current place in health care, and uses 4 aspects (management, technology, security, and legal) to evaluate the opportunities and challenges of this computing model. Strategic planning that could be used by a health organization to determine its direction, strategy, and resource allocation when it has decided to migrate from traditional to cloud-based health services is also discussed. PMID:21937354

Technologies for HIV prevention and care: challenges for health services.

PubMed

Maksud, Ivia; Fernandes, Nilo Martinez; Filgueiras, Sandra Lucia

2015-09-01

This article aims to consider some relevant challenges to the provision of "new prevention technologies" in health services in a scenario where the "advances" in the global response to AIDS control are visible. We take as material for analysis the information currently available on the HIV post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), treatment as prevention (TASP) and over the counter. The methodology consisted of the survey and analysis of the Biblioteca Virtual em Saúde (BVS: MEDLINE, LILACS, WHOLIS, PAHO, SciELO) articles that addressed the issue of HIV prevention and care in the context of so-called new prevention technologies. The results of the studies show that there is assistance on the ground of clinics for the treatment of disease responses, but there are several challenges related to the sphere of prevention. The articles list some challenges regarding to management, organization of services and the attention given by health professionals to users. The current context shows evidence of the effectiveness of antiretroviral therapy in reducing the risk of HIV transmission, but the challenges for the provision of preventive technologies in health services permeate health professionals and users in their individual dimensions and health services in organizational and structural dimension. Interventions should be made available in a context of community mobilization; there should be no pressure on people to make HIV testing, antiretroviral treatment or for prevention. In the management is responsible for the training of health professionals to inform, clarify and make available to users, partners and family information about the new antiretroviral use strategies.

How do informal self-care strategies evolve among patients with chronic obstructive pulmonary disease managed in primary care? A qualitative study.

PubMed

Apps, Lindsay D; Harrison, Samantha L; Williams, Johanna E A; Hudson, Nicky; Steiner, Michael; Morgan, Mike D; Singh, Sally J

2014-01-01

There is much description in the literature of how patients with chronic obstructive pulmonary disease (COPD) manage their breathlessness and engage in self-care activities; however, little of this is from the perspective of those with less severe disease, who are primarily managed in primary care. This study aimed to understand the self-care experiences of patients with COPD who are primarily managed in primary care, and to examine the challenges of engaging in such behaviors. Semistructured interviews were carried out with 15 patients with COPD as part of a larger project evaluating a self-management intervention. Thematic analysis was supported by NVivo software (version 8, QSR International, Melbourne, Australia). Three main themes are described, ie, experiencing and understanding symptoms of COPD, current self-care activities, and the importance of family perceptions in managing COPD. Self-care activities evolved spontaneously as participants experienced symptoms of COPD. However, there was a lack of awareness about whether these strategies would impact upon symptoms. Perceptions of COPD by family members posed a challenge to self-care for some participants. Health care professionals should elicit patients' prior disease experiences and utilize spontaneous attempts at disease management in future self-management. These findings have implications for promoting self-management and enhancing quality of life.

Staying Connected: Sustaining Collaborative Care Models with Limited Funding.

PubMed

Johnston, Brenda J; Peppard, Lora; Newton, Marian

2015-08-01

Providing psychiatric services in the primary care setting is challenging. The multidisciplinary, coordinated approach of collaborative care models (CCMs) addresses these challenges. The purpose of the current article is to discuss the implementation of a CCM at a free medical clinic (FMC) where volunteer staff provide the majority of services. Essential components of CCMs include (a) comprehensive screening and assessment, (b) shared development and communication of care plans among providers and the patient, and (c) care coordination and management. Challenges to implementing and sustaining a CCM at a FMC in Virginia attempting to meet the medical and psychiatric needs of the underserved are addressed. Although the CCM produced favorable outcomes, sustaining the model long-term presented many challenges. Strategies for addressing these challenges are discussed. Copyright 2015, SLACK Incorporated.

Acoustic telemetry observation systems: challenges encountered and overcome in the Laurentian Great Lakes

USGS Publications Warehouse

Krueger, Charles C.; Holbrook, Christopher; Binder, Thomas R.; Vandergoot, Christopher; Hayden, Todd A.; Hondorp, Darryl W.; Nate, Nancy; Paige, Kelli; Riley, Stephen; Fisk, Aaron T.; Cooke, Steven J.

2017-01-01

The Great Lakes Acoustic Telemetry Observation System (GLATOS), organized in 2012, aims to advance and improve conservation and management of Great Lakes fishes by providing information on behavior, habitat use, and population dynamics. GLATOS faced challenges during establishment, including a funding agency-imposed urgency to initiate projects, a lack of telemetry expertise, and managing a flood of data. GLATOS now connects 190+ investigators, provides project consultation, maintains a web-based data portal, contributes data to Ocean Tracking Network’s global database, loans equipment, and promotes science transfer to managers. The GLATOS database currently has 50+ projects, 39 species tagged, 8000+ fish released, and 150+ million tag detections. Lessons learned include (1) seek advice from others experienced in telemetry; (2) organize networks prior to when shared data is urgently needed; (3) establish a data management system so that all receivers can contribute to every project; (4) hold annual meetings to foster relationships; (5) involve fish managers to ensure relevancy; and (6) staff require full-time commitment to lead and coordinate projects and to analyze data and publish results.

Big data management challenges in health research-a literature review.

PubMed

Wang, Xiaoming; Williams, Carolyn; Liu, Zhen Hua; Croghan, Joe

2017-08-07

Big data management for information centralization (i.e. making data of interest findable) and integration (i.e. making related data connectable) in health research is a defining challenge in biomedical informatics. While essential to create a foundation for knowledge discovery, optimized solutions to deliver high-quality and easy-to-use information resources are not thoroughly explored. In this review, we identify the gaps between current data management approaches and the need for new capacity to manage big data generated in advanced health research. Focusing on these unmet needs and well-recognized problems, we introduce state-of-the-art concepts, approaches and technologies for data management from computing academia and industry to explore improvement solutions. We explain the potential and significance of these advances for biomedical informatics. In addition, we discuss specific issues that have a great impact on technical solutions for developing the next generation of digital products (tools and data) to facilitate the raw-data-to-knowledge process in health research. Published by Oxford University Press 2017. This work is written by US Government employees and is in the public domain in the US.

Renewing Occupational Cultures--Bridging Boundaries in Learning Spaces

ERIC Educational Resources Information Center

Kalliola, Satu; Nakari, Risto

2007-01-01

Professional bureaucracies of the Finnish municipal services are challenged by many modernization pressures manifested currently in the form of New Public Management. Along with efficiency demands the new emphasis is on the provision of client-oriented services by the means of multi-professional teamwork crossing the traditional sector boundaries.…

WATER QUALITY AND THE REPLACEMENT AND REPAIR OF DRINKING WATER INFRASTRUCTURE: THE WASHINGTON, DC CASE STUDY

EPA Science Inventory

A major challenge for society in the 21st century will be replacement, design and optimal management of urban infrastructure. It is estimated that the current world wide demand for infrastructure investment is approximately three trillion US dollars annually. Many developing coun...

Nitrogen Balance and Use Efficiency in the Calapooia River Watershed, Oregon, United States

EPA Science Inventory

Reducing nitrogen (N) release into the environment through greater N use efficiencies (NUE) is a current challenge in watershed management. Examining N sources and sinks at local scales allows for better watershed-scale N use, for example when considering the tradeoffs between th...

Women's Health USA, 2003.

ERIC Educational Resources Information Center

Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Bureau of Maternal and Child Health and Resources Development.

This book provides a collection of current and historical data on some of the most pressing health challenges facing women, their families, and their communities. It is intended to be a concise reference for policymakers and program managers at the federal, state, and local levels. The book brings together the latest available data from various…

Current Issues in Chinese Higher Education. Education and Skills.

ERIC Educational Resources Information Center

Organisation for Economic Cooperation and Development, Paris (France).

The papers in this collection discuss the challenges and opportunities inherent in the fundamental reforms under way in the higher education sector in China. The chapters are: (1) "Introduction: Changing Patterns in University Management" (Thomas J. Alexander); (2) "What Is Facing Chinese Higher Education in the New Century?"…

Integrative knowledge management to enhance pharmaceutical R&D.

PubMed

Marti-Solano, Maria; Birney, Ewan; Bril, Antoine; Della Pasqua, Oscar; Kitano, Hiroaki; Mons, Barend; Xenarios, Ioannis; Sanz, Ferran

2014-04-01

Information technologies already have a key role in pharmaceutical research and development (R&D), but achieving substantial advances in their use and effectiveness will depend on overcoming current challenges in sharing, integrating and jointly analysing the range of data generated at different stages of the R&D process.

Methodological Reflections: Designing and Understanding Computer-Supported Collaborative Learning

ERIC Educational Resources Information Center

Hamalainen, Raija

2012-01-01

Learning involves more than just a small group of participants, which makes designing and managing collaborative learning processes in higher education a challenging task. As a result, emerging concerns in current research have pointed increasingly to teacher orchestrated learning processes in naturalistic learning settings. In line with this…

Philosophy, Kairosophy and the Lesson of Time

ERIC Educational Resources Information Center

Papastephanou, Marianna

2014-01-01

The conception of time that dominates in the educational world of today is that of measurable, invested and managed chronological time. It is the conception of time that corresponds to current priorities such as performativity, global synchronization of educational systems, raising standards and meeting the challenges of the market. The…

Time--It's Not Always Money

ERIC Educational Resources Information Center

Gabrieli, Chris

2012-01-01

In a time of resource challenges, many educators see the cost of expanding learning time as a barrier. However, with at least 1,000 schools across the United States currently expanding learning time, data show that schools can implement the approach cost effectively. Expanded learning time schools manage three levers that both build quality…

Evaluation of the Service Review Model with Performance Scorecards

ERIC Educational Resources Information Center

Szabo, Thomas G.; Williams, W. Larry; Rafacz, Sharlet D.; Newsome, William; Lydon, Christina A.

2012-01-01

The current study combined a management technique termed "Service Review" with performance scorecards to enhance staff and consumer behavior in a human service setting consisting of 11 supervisors and 56 front-line staff working with 9 adult consumers with challenging behaviors. Results of our intervention showed that service review and…

Topics in Finance Part VI--Capital Budgeting

ERIC Educational Resources Information Center

Laux, Judy

2011-01-01

This series on the theory of financial management offers insight into the roles of stockholder wealth maximization, the risk-return tradeoff, and agency conflicts as they apply to major topics in finance. The current article investigates capital budgeting. Much literature addresses this topic, with a number of articles challenging mainstream…

Gamma irradiation inactivates honey bee fungal, microsporidian, and viral pathogens and parasites

USDA-ARS?s Scientific Manuscript database

Managed honey bee (Apis mellifera) populations are currently facing unsustainable losses due to a variety of factors. Colonies are challenged with brood pathogens, such as the fungal agent of chalkbrood disease, the microsporidian gut parasite Nosema sp., and several viruses. These pathogens may be ...

Ben's Plastic Brain

ERIC Educational Resources Information Center

Kaplan, Susan L.

2010-01-01

This article shares a story of Ben who as a result of his premature birth, suffered a brain hemorrhage resulting in cerebral palsy, which affected his left side (left hemiparesis) and caused learning disabilities. Despite these challenges, he graduated from college and currently works doing information management for a local biotech start-up…

Tendinopathy: injury, repair, and current exploration

PubMed Central

Lipman, Kelsey; Wang, Chenchao; Ting, Kang; Soo, Chia; Zheng, Zhong

2018-01-01

Both acute and chronic tendinopathy result in high morbidity, requiring management that is often lengthy and expensive. However, limited and conflicting scientific evidence surrounding current management options has presented a challenge when trying to identify the best treatment for tendinopathy. As a result of shortcomings of current treatments, response to available therapies is often poor, resulting in frustration in both patients and physicians. Due to a lack of understanding of basic tendon-cell biology, further scientific investigation is needed in the field for the development of biological solutions. Optimization of new delivery systems and therapies that spatially and temporally mimic normal tendon physiology hold promise for clinical application. This review focuses on the clinical importance of tendinopathy, the structure of healthy tendons, tendon injury, and healing, and a discussion of current approaches for treatment that highlight the need for the development of new nonsurgical interventions. PMID:29593382

Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management

PubMed Central

2012-01-01

Background In 2003 Ghana introduced a social health insurance scheme which resulted in the separation of purchasing of health services by the health insurance authority on the one hand and the provision of health services by hospitals at the other side of the spectrum. This separation has a lot of implications for managing accredited hospitals. This paper examines whether decoupling purchasing and service provision translate into opportunities or challenges in the management of accredited hospitals. Methods A qualitative exploratory study of 15 accredited district hospitals were selected from five of Ghana’s ten administrative regions for the study. A semi-structured interview guide was designed to solicit information from key informants, Health Service Administrators, Pharmacists, Accountants and Scheme Managers of the hospitals studied. Data was analysed thematically. Results The results showed that under the health insurance scheme, hospitals are better-off in terms of cash flow and adequate stock levels of drugs. Adequate stock of non-drugs under the scheme was reportedly intermittent. The major challenges confronting the hospitals were identified as weak purchasing power due to low tariffs, non computerisation of claims processing, unpredictable payment pattern, poor gate-keeping systems, lack of logistics and other new and emerging challenges relating to moral hazards and the use of false identity cards under pretence for medical care. Conclusion Study’s findings have a lot of policy implications for proper management of hospitals. The findings suggest rationalisation of the current tariff structure, the application of contract based payment system to inject efficiency into hospitals management and piloting facility based vetting systems to offset vetting loads of the insurance authority. Proper gate-keeping mechanisms are also needed to curtail the phenomenon of moral hazard and false documentation. PMID:22726666

Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management.

PubMed

Atinga, Roger A; Mensah, Sylvester A; Asenso-Boadi, Francis; Adjei, Francis-Xavier Andoh

2012-06-22

In 2003 Ghana introduced a social health insurance scheme which resulted in the separation of purchasing of health services by the health insurance authority on the one hand and the provision of health services by hospitals at the other side of the spectrum. This separation has a lot of implications for managing accredited hospitals. This paper examines whether decoupling purchasing and service provision translate into opportunities or challenges in the management of accredited hospitals. A qualitative exploratory study of 15 accredited district hospitals were selected from five of Ghana's ten administrative regions for the study. A semi-structured interview guide was designed to solicit information from key informants, Health Service Administrators, Pharmacists, Accountants and Scheme Managers of the hospitals studied. Data was analysed thematically. The results showed that under the health insurance scheme, hospitals are better-off in terms of cash flow and adequate stock levels of drugs. Adequate stock of non-drugs under the scheme was reportedly intermittent. The major challenges confronting the hospitals were identified as weak purchasing power due to low tariffs, non computerisation of claims processing, unpredictable payment pattern, poor gate-keeping systems, lack of logistics and other new and emerging challenges relating to moral hazards and the use of false identity cards under pretence for medical care. Study's findings have a lot of policy implications for proper management of hospitals. The findings suggest rationalisation of the current tariff structure, the application of contract based payment system to inject efficiency into hospitals management and piloting facility based vetting systems to offset vetting loads of the insurance authority. Proper gate-keeping mechanisms are also needed to curtail the phenomenon of moral hazard and false documentation.

Optimising the use of observational electronic health record data: Current issues, evolving opportunities, strategies and scope for collaboration.

PubMed

Liaw, Siaw-Teng; Powell-Davies, Gawaine; Pearce, Christopher; Britt, Helena; McGlynn, Lisa; Harris, Mark F

2016-03-01

With increasing computerisation in general practice, national primary care networks are mooted as sources of data for health services and population health research and planning. Existing data collection programs - MedicinesInsight, Improvement Foundation, Bettering the Evaluation and Care of Health (BEACH) - vary in purpose, governance, methodologies and tools. General practitioners (GPs) have significant roles as collectors, managers and users of electronic health record (EHR) data. They need to understand the challenges to their clinical and managerial roles and responsibilities. The aim of this article is to examine the primary and secondary use of EHR data, identify challenges, discuss solutions and explore directions. Representatives from existing programs, Medicare Locals, Local Health Districts and research networks held workshops on the scope, challenges and approaches to the quality and use of EHR data. Challenges included data quality, interoperability, fragmented governance, proprietary software, transparency, sustainability, competing ethical and privacy perspectives, and cognitive load on patients and clinicians. Proposed solutions included effective change management; transparent governance and management of intellectual property, data quality, security, ethical access, and privacy; common data models, metadata and tools; and patient/community engagement. Collaboration and common approaches to tools, platforms and governance are needed. Processes and structures must be transparent and acceptable to GPs.

Fossil energy waste management. Technology status report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bossart, S.J.; Newman, D.A.

1995-02-01

This report describes the current status and recent accomplishments of the Fossil Energy Waste Management (FE WM) projects sponsored by the Morgantown Energy Technology Center (METC) of the US Department of Energy (DOE). The primary goal of the Waste Management Program is to identify and develop optimal strategies to manage solid by-products from advanced coal technologies for the purpose of ensuring the competitiveness of advanced coal technologies as a future energy source. The projects in the Fossil Energy Waste Management Program are divided into three types of activities: Waste Characterization, Disposal Technologies, and Utilization Technologies. This technology status report includesmore » a discussion on barriers to increased use of coal by-products. Also, the major technical and nontechnical challenges currently being addressed by the FE WM program are discussed. A bibliography of 96 citations and a list of project contacts is included if the reader is interested in obtaining additional information about the FE WM program.« less

Achieving competitive advantage through strategic human resource management.

PubMed

Fottler, M D; Phillips, R L; Blair, J D; Duran, C A

1990-01-01

The framework presented here challenges health care executives to manage human resources strategically as an integral part of the strategic planning process. Health care executives should consciously formulate human resource strategies and practices that are linked to and reinforce the broader strategic posture of the organization. This article provides a framework for (1) determining and focusing on desired strategic outcomes, (2) identifying and implementing essential human resource management actions, and (3) maintaining or enhancing competitive advantage. The strategic approach to human resource management includes assessing the organization's environment and mission; formulating the organization's business strategy; assessing the human resources requirements based on the intended strategy; comparing the current inventory of human resources in terms of numbers, characteristics, and human resource management practices with respect to the strategic requirements of the organization and its services or product lines; formulating the human resource strategy based on the differences between the assessed requirements and the current inventory; and implementing the appropriate human resource practices to reinforce the strategy and attain competitive advantage.

Regional approaches to the management of patients with advanced, radioactive iodine-refractory differentiated thyroid carcinoma.

PubMed

Brose, Marcia S; Smit, Johannes; Capdevila, Jaume; Elisei, Rossella; Nutting, Christopher; Pitoia, Fabian; Robinson, Bruce; Schlumberger, Martin; Shong, Young Kee; Takami, Hiroshi

2012-09-01

For patients with advanced, radioactive iodine-refractory differentiated thyroid cancer, current treatment guidelines recommend clinical trial enrollment or small-molecule kinase inhibitor therapy. However, details of patient management vary between countries depending on trial availability and national regulatory policies. Insufficient clinical trial data and variable disease characteristics challenge the creation of universal guidelines, and treatment plans often reflect regional influences. A multidisciplinary, multiregional panel of experts met to discuss regional approaches to managing patients with advanced, radioactive iodine-refractory differentiated thyroid cancer and the potential impact of emerging therapies on current treatment strategies. Despite process-oriented regional differences, the decision-making strategies were similar. Multidisciplinary teams used to manage high-risk patients varied in composition across regions, particularly regarding the responsible physician's specialty. Cytotoxic chemotherapy was viewed as limited in clinical benefit, and targeted agents as attractive, based on promising data. Panel members support clinical trial enrollment as the preferred treatment strategy for managing these patients.

Emergency response to mass casualty incidents in Lebanon.

PubMed

El Sayed, Mazen J

2013-08-01

The emergency response to mass casualty incidents in Lebanon lacks uniformity. Three recent large-scale incidents have challenged the existing emergency response process and have raised the need to improve and develop incident management for better resilience in times of crisis. We describe some simple emergency management principles that are currently applied in the United States. These principles can be easily adopted by Lebanon and other developing countries to standardize and improve their emergency response systems using existing infrastructure.

Riparian ecosystem resilience and livelihood strategies under test: lessons from Lake Chilwa in Malawi and other lakes in Africa.

PubMed

Kafumbata, Dalitso; Jamu, Daniel; Chiotha, Sosten

2014-04-05

This paper reviews the importance of African lakes and their management challenges. African inland lakes contribute significantly to food security, livelihoods and national economies through direct exploitation of fisheries, water resources for irrigation and hydropower generation. Because of these key contributions, the ecosystem services provided are under significant stress mainly owing to high demand by increasing populations, negative anthropogenic impacts on lake catchments and high levels of poverty which result in unsustainable use. Climate variability exacerbates the stress on these ecosystems. Current research findings show that the lakes cannot sustain further development activities on the scale seen over the past few decades. Millions of people are at risk of losing livelihoods through impacts on livestock and wildlife. The review further shows that the problems facing these lakes are beyond the purview of current management practices. A much better understanding of the interactions and feedbacks between different components of the lake socio-ecological systems is needed to address the complex challenges of managing these ecosystem services. This review suggests that the three small wetlands of Chad, Chilwa and Naivasha provide an opportunity for testing novel ideas that integrate sustainability of natural resource management with livelihoods in order to inform policy on how future land use and climatic variability will affect both food security and the ecosystem services associated with it.

Management of uncommon disorders in pregnancy: Von Hippel-Lindau disease, Gitelman syndrome, and Nutcracker syndrome.

PubMed

Merhi, Basma; Miller, Margaret; Lanis, Aviya; Katz, Brittany; Hsu, Tiffany; Tong, Iris

2017-09-01

Uncommon renal disorders in pregnancy can be challenging to manage given limited evidence in the literature to guide management. We present a series of three uncommon renal disorders in pregnancy: Von Hippel-Lindau disease, Gitelman syndrome, and Nutcracker syndrome. Previously published case reports with differing outcomes offer some guidance to the management of these disorders in pregnancy. In this case series, we address the management of these syndromes during pregnancy and discuss the maternal and fetal outcomes. All three of our patients had good maternal and fetal outcomes, which will contribute to current data on maternal and fetal outcomes in these rare diseases, which is limited.

The case for undergraduate medical education in healthcare business and management.

PubMed

Hsu, Benson S; Hosokawa, Michael C; Maria, Bernard

2007-01-01

Current undergraduate medical education does notprepare students to approach the intricacies of healthcare business. This absence within medical education creates significant challenges for physicians throughout their careers. The field of academic medicine has clearly documented the need for medical education to prepare students for practice management, yet there exist only a small number of attempts at exposing students to healthcare business and management. The authors argue that this curriculum must start at the level ofundergraduate medical education. Furthermore, this curriculum must possess the basic components of support, integration, practicality, application, and continuation. Fulfilling these requirements will allow for the successful adaptation of the healthcare business and management curriculum.

Transformational leadership to promote cross-generational retention.

PubMed

Lobo, Vanessa M

2010-05-01

As the current nursing shortage intensifies under the weight of an aging population, retention of front-line staff is becoming paramount. Studies have consistently demonstrated that the leadership style of nurse managers plays a significant role to this end. This paper describes some of the challenges that managers encounter in their dealings with the contemporary multigenerational workforce - including the baby boomers, generation X and generation Y (the "millennials"). A review of research findings suggests the insufficiency of a single leadership approach to nurse management compared to more tailored generational strategies. Application of the transformational leadership model provides the background and tenets from which solutions are proposed for multigenerational management.

General concepts in the management of a kidney transplant.

PubMed

Ortiz-Heredia, Luis; Cangiano, Jose L

2011-01-01

The management of a kidney transplant patient is, in most cases, challenging and requires a multidisciplinary approach. For the physician caring for the patient it is imperative to have a broad knowledge regarding several concepts on their management, as they are increasingly faced with long-term care. Baseline rapport and accessibility provides a pivotal role in the treatment, monitoring and preventive measures in the kidney transplant patient. Currently, most aspects regarding patient management vary according to each transplant center. This article describes the importance of several medical issues directed towards the clinician aiming to improve awareness and expand knowledge, with the development of a systematic approach.

Use of decision support systems as a drought management tool

USGS Publications Warehouse

Frevert, D.; Lins, H.; ,

2005-01-01

Droughts present a unique challenge to water managers throughout the world and the current drought in the western United States is taxing facilities to the limit. Coping with this severe drought requires state of the art decision support systems including efficient and accurate hydrologic process models, detailed hydrologic data bases and effective river systems management modeling frameworks. This paper will outline a system of models developed by the Bureau of Reclamation, the US Geological Survey, the University of Colorado and a number of other governmental and university partners. The application of the technology to drought management in several key western river basins will be discussed.

Nutritional Management in Enterocutaneous Fistula. What is the evidence?

PubMed Central

BADRASAWI, Manal; SHAHAR, Suzana; SAGAP, Ismail

2015-01-01

The management of Enterocutaneous fistula (ECF) is challenging. It remains associated with morbidity and mortality, despite advancements in medical and surgical therapies. Early nutritional support using parenteral, enteral or fystuloclysis routs is essential to reverse catabolism and replace nutrients, fluid and electrolyte losses. This study aims to review the current literature on the management of ECF. Fistulae classifications have an impact on the calories and protein requirements. Early nutritional support with parenteral, enteral nutrition or fistuloclysis played a significant role in the management outcome. Published literature on the nutritional management of ECF is mostly retrospective and lacks experimental design. Prospective studies do not investigate nutritional assessment or management experimentally. Individualising the nutritional management protocol was recommended due to the absence of management guidelines for ECF patients. PMID:26715903

Spatial-temporal variability in groundwater abstraction across Uganda: Implications to sustainable water resources management

NASA Astrophysics Data System (ADS)

Nanteza, J.; Thomas, B. F.; Mukwaya, P. I.

2017-12-01

The general lack of knowledge about the current rates of water abstraction/use is a challenge to sustainable water resources management in many countries, including Uganda. Estimates of water abstraction/use rates over Uganda, currently available from the FAO are not disaggregated according to source, making it difficult to understand how much is taken out of individual water stores, limiting effective management. Modelling efforts have disaggregated water use rates according to source (i.e. groundwater and surface water). However, over Sub-Saharan Africa countries, these model use estimates are highly uncertain given the scale limitations in applying water use (i.e. point versus regional), thus influencing model calibration/validation. In this study, we utilize data from the water supply atlas project over Uganda to estimate current rates of groundwater abstraction across the country based on location, well type and other relevant information. GIS techniques are employed to demarcate areas served by each water source. These areas are combined with past population distributions and average daily water needed per person to estimate water abstraction/use through time. The results indicate an increase in groundwater use, and isolate regions prone to groundwater depletion where improved management is required to sustainably management groundwater use.

Assessing and Managing the Current and Future Pest Risk from Water Hyacinth, (Eichhornia crassipes), an Invasive Aquatic Plant Threatening the Environment and Water Security.

PubMed

Kriticos, Darren J; Brunel, Sarah

2016-01-01

Understanding and managing the biological invasion threats posed by aquatic plants under current and future climates is a growing challenge for biosecurity and land management agencies worldwide. Eichhornia crassipes is one of the world's worst aquatic weeds. Presently, it threatens aquatic ecosystems, and hinders the management and delivery of freshwater services in both developed and developing parts of the world. A niche model was fitted using CLIMEX, to estimate the potential distribution of E. crassipes under historical and future climate scenarios. Under two future greenhouse gas emission scenarios for 2080 simulated with three Global Climate Models, the area with a favourable temperature regime appears set to shift polewards. The greatest potential for future range expansion lies in Europe. Elsewhere in the northern hemisphere temperature gradients are too steep for significant geographical range expansion under the climate scenarios explored here. In the Southern Hemisphere, the southern range boundary for E. crassipes is set to expand southwards in Argentina, Australia and New Zealand; under current climate conditions it is already able to invade the southern limits of Africa. The opportunity exists to prevent its spread into the islands of Tasmania in Australia and the South Island of New Zealand, both of which depend upon hydroelectric facilities that would be threatened by the presence of E. crassipes. In Europe, efforts to slow or stop the spread of E. crassipes will face the challenge of limited internal biosecurity capacity. The modelling technique demonstrated here is the first application of niche modelling for an aquatic weed under historical and projected future climates. It provides biosecurity agencies with a spatial tool to foresee and manage the emerging invasion threats in a manner that can be included in the international standard for pest risk assessments. It should also support more detailed local and regional management.

Assessing and Managing the Current and Future Pest Risk from Water Hyacinth, (Eichhornia crassipes), an Invasive Aquatic Plant Threatening the Environment and Water Security

PubMed Central

Brunel, Sarah

2016-01-01

Understanding and managing the biological invasion threats posed by aquatic plants under current and future climates is a growing challenge for biosecurity and land management agencies worldwide. Eichhornia crassipes is one of the world’s worst aquatic weeds. Presently, it threatens aquatic ecosystems, and hinders the management and delivery of freshwater services in both developed and developing parts of the world. A niche model was fitted using CLIMEX, to estimate the potential distribution of E. crassipes under historical and future climate scenarios. Under two future greenhouse gas emission scenarios for 2080 simulated with three Global Climate Models, the area with a favourable temperature regime appears set to shift polewards. The greatest potential for future range expansion lies in Europe. Elsewhere in the northern hemisphere temperature gradients are too steep for significant geographical range expansion under the climate scenarios explored here. In the Southern Hemisphere, the southern range boundary for E. crassipes is set to expand southwards in Argentina, Australia and New Zealand; under current climate conditions it is already able to invade the southern limits of Africa. The opportunity exists to prevent its spread into the islands of Tasmania in Australia and the South Island of New Zealand, both of which depend upon hydroelectric facilities that would be threatened by the presence of E. crassipes. In Europe, efforts to slow or stop the spread of E. crassipes will face the challenge of limited internal biosecurity capacity. The modelling technique demonstrated here is the first application of niche modelling for an aquatic weed under historical and projected future climates. It provides biosecurity agencies with a spatial tool to foresee and manage the emerging invasion threats in a manner that can be included in the international standard for pest risk assessments. It should also support more detailed local and regional management. PMID:27513336

Meeting the policy agenda, part 1: the role of the modern district nurse.

PubMed

Dickson, Caroline A W; Gough, Helen; Bain, Heather

2011-10-01

The challenges posed by the current context of health and social care offer opportunities for different models of care delivery. District nursing has evolved, and continues to evolve to meet these challenges. The traditional reactive role of district nursing has developed as contemporary practice expects district nurses to meet both planned and unplanned care required by practice populations. Modern anticipatory care approaches to care are being adopted, while care and case management is being facilitated and delivered to patients and families with complex health and social care needs. Additionally, district nurses are recognizing the need to further develop management and leadership skills as the teams delivering care consist of a skill mix of nurses and other disciplines. They are also charged with evidencing the impact of what they do and influencing care delivery at every level of healthcare organizations. This first paper of two will explore the current UK policy context and ways in which district nursing services within each country are changing to meet the challenges posed. A second article will argue the need to ensure the district nursing workforce is underpinned by robust educational standards that ensure protection of the public. The influences of education and development from professional and organizational perspectives will be examined.

Integrated landscape approaches to managing social and environmental issues in the tropics: learning from the past to guide the future.

PubMed

Reed, James; Van Vianen, Josh; Deakin, Elizabeth L; Barlow, Jos; Sunderland, Terry

2016-07-01

Poverty, food insecurity, climate change and biodiversity loss continue to persist as the primary environmental and social challenges faced by the global community. As such, there is a growing acknowledgement that conventional sectorial approaches to addressing often inter-connected social, environmental, economic and political challenges are proving insufficient. An alternative is to focus on integrated solutions at landscape scales or 'landscape approaches'. The appeal of landscape approaches has resulted in the production of a significant body of literature in recent decades, yet confusion over terminology, application and utility persists. Focusing on the tropics, we systematically reviewed the literature to: (i) disentangle the historical development and theory behind the framework of the landscape approach and how it has progressed into its current iteration, (ii) establish lessons learned from previous land management strategies, (iii) determine the barriers that currently restrict implementation of the landscape approach and (iv) provide recommendations for how the landscape approach can contribute towards the fulfilment of the goals of international policy processes. This review suggests that, despite some barriers to implementation, a landscape approach has considerable potential to meet social and environmental objectives at local scales while aiding national commitments to addressing ongoing global challenges. © 2016 John Wiley & Sons Ltd.

Approach to the E-ELT dome and main structure challenges

NASA Astrophysics Data System (ADS)

Bilbao, Armando; Murga, Gaizka; Gómez, Celia; Llarena, Javier

2014-07-01

The E-ELT as a whole could be classified as an extremely challenging project. More precisely, it should be defined as an array of many different sub-challenges, which comprise technical, logistical and managerial matters. This paper reviews some of these critical challenges, in particular those related to the Dome and the Main Structure, suggesting ways to face them in the most pragmatic way possible. Technical challenges for the Dome and the Main Structure are mainly related to the need to upscale current design standards to an order of magnitude larger design. Trying a direct design escalation is not feasible; it would not work. A design effort is needed to cross hybridize current design standards with technologies coming from other different applications. Innovative design is therefore not a wish but a must. And innovative design comes along with design risk. Design risk needs to be tackled from two angles: on the one hand through thorough design validation analysis and on the other hand through extensive pre-assembly and testing. And, once again, full scale integrated pre-assembly and testing of extremely large subsystems is not always possible. Therefore, defining a comprehensive test plan for critical components, critical subsystems and critical subassemblies becomes essential. Logistical challenges are linked to the erection site. Cerro Armazones is a remote site and this needs to be considered when evaluating transport and erection requirements. But it is not only the remoteness of the site that needs to be considered. The size of both Dome and Main Structure require large construction cranes and a well defined erection plan taking into account pre-assembly strategies, limited plan area utilization, erection sequence, erection stability during intermediate stages and, very specifically, efficient coordination between the Dome and the Main Structure erection processes. Managerial issues pose another set of challenges in this project. Both the size of the project and its special technical characteristics require specific managerial skills. Due to the size of the project it becomes essential to effectively manage and integrate a large number of suppliers and fabricators, of very different nature and geographically distributed. Project management plans need to cope with this situation. Also, extensive on site activities require intensive on site organization in line with large construction management strategies. Finally, the technical edge of the project requires deep technical understanding at management level in order to be able to take sound strategic decisions throughout the project in terms of the overall project quality, cost and schedule.

Challenges for the implementation of World Health Organization guidelines for acute stress, PTSD, and bereavement: a qualitative study in Uganda.

PubMed

Kane, Jeremy C; Adaku, Alex; Nakku, Juliet; Odokonyero, Raymond; Okello, James; Musisi, Seggane; Augustinavicius, Jura; Greene, M Claire; Alderman, Steve; Tol, Wietse A

2016-03-15

In 2013, the World Health Organization (WHO) published new guidelines for the management of conditions specifically related to stress, including symptoms of acute stress, bereavement, and post-traumatic stress disorder (PTSD). It is important to evaluate potential challenges for the implementation of these guidelines in low-resource settings, however, there is a dearth of research in this area. The current qualitative study aimed to assess perspectives on the feasibility and acceptability of the new guidelines in four clinics that provide mental health services in post-conflict northern Uganda. In-depth interviews were conducted with 19 mental health-care providers and program developers in northern Uganda to address three major research objectives: (1) describe the current standard practices and guidelines used for treating conditions related to stress in Uganda; (2) identify barriers and challenges associated with implementing the new WHO guidelines; and (3) identify and describe potential strategies for overcoming these barriers and challenges. An emergent thematic analysis was used to develop a coding scheme for the transcribed interviews. Practices for managing conditions related to stress included group psychological interventions, psychoeducation, and medication for clients with severe signs and symptoms. Several themes were identified from the interviews on barriers to guideline implementation. These included (1) a lack of trained and qualified mental health professionals to deliver WHO-recommended psychological interventions; (2) a perception that psychological interventions developed in high-income countries would not be culturally adaptable in Uganda; and (3) reluctance about blanket statements regarding medication for the management of acute stress symptoms and PTSD. Identified strategies for overcoming these barriers included (1) training and capacity building for current mental health staff; (2) a stepped care approach to mental health services; and (3) cultural modification of psychological interventions to improve treatment acceptability by clients. Guidelines were viewed positively by mental health professionals in Uganda, but barriers to implementation were expressed. Recommendations for implementation include (1) strengthening knowledge on effectiveness of existing cultural practices for improving mental health; (2) improving supervision capacity of current mental health staff to address shortage in human resources; and (3) increasing awareness of help-seeking clients on the potential effectiveness of psychological vs. pharmacological interventions.

An electronic regulatory document management system for a clinical trial network.

PubMed

Zhao, Wenle; Durkalski, Valerie; Pauls, Keith; Dillon, Catherine; Kim, Jaemyung; Kolk, Deneil; Silbergleit, Robert; Stevenson, Valerie; Palesch, Yuko

2010-01-01

A computerized regulatory document management system has been developed as a module in a comprehensive Clinical Trial Management System (CTMS) designed for an NIH-funded clinical trial network in order to more efficiently manage and track regulatory compliance. Within the network, several institutions and investigators are involved in multiple trials, and each trial has regulatory document requirements. Some of these documents are trial specific while others apply across multiple trials. The latter causes a possible redundancy in document collection and management. To address these and other related challenges, a central regulatory document management system was designed. This manuscript shares the design of the system as well as examples of it use in current studies. Copyright (c) 2009 Elsevier Inc. All rights reserved.

Current Challenges in Geothermal Reservoir Simulation

NASA Astrophysics Data System (ADS)

Driesner, T.

2016-12-01

Geothermal reservoir simulation has long been introduced as a valuable tool for geothermal reservoir management and research. Yet, the current generation of simulation tools faces a number of severe challenges, in particular in the application for novel types of geothermal resources such as supercritical reservoirs or hydraulic stimulation. This contribution reviews a number of key problems: Representing the magmatic heat source of high enthalpy resources in simulations. Current practice is representing the deeper parts of a high enthalpy reservoir by a heat flux or temperature boundary condition. While this is sufficient for many reservoir management purposes it precludes exploring the chances of very high enthalpy resources in the deepest parts of such systems as well as the development of reliable conceptual models. Recent 2D simulations with the CSMP++ simulation platform demonstrate the potential of explicitly including the heat source, namely for understanding supercritical resources. Geometrically realistic incorporation of discrete fracture networks in simulation. A growing number of simulation tools can, in principle, handle flow and heat transport in discrete fracture networks. However, solving the governing equations and representing the physical properties are often biased by introducing strongly simplifying assumptions. Including proper fracture mechanics in complex fracture network simulations remains an open challenge. Improvements of the simulating chemical fluid-rock interaction in geothermal reservoirs. Major improvements have been made towards more stable and faster numerical solvers for multicomponent chemical fluid rock interaction. However, the underlying thermodynamic models and databases are unable to correctly address a number of important regions in temperature-pressure-composition parameter space. Namely, there is currently no thermodynamic formalism to describe relevant chemical reactions in supercritical reservoirs. Overcoming this unsatisfactory situation requires fundamental research in high temperature physical chemistry rather than further numerical development.

Toward a better understanding of the future of the solo medical practitioner in health care industry: a conceptual review.

PubMed

Erdem, S A; Lacombe, B

1998-01-01

Even a brief conceptual review of the current developments in the health care industry indicates that the future of independent medical practitioners is rather challenging. It may be necessary for these parties to pursue proactive and aggressive marketing strategies to be able to compete with the managed care organizations. Accordingly, this paper outlines some of the current trends in health care marketing as they relate to the ongoing changes to which solo medical practitioners need to respond. It is hoped that the review of the issues raised in this paper can provide an initial basis for a better understanding of some of the challenges to come up with more comprehensive and effective strategy decisions.

Oral health in Libya: addressing the future challenges.

PubMed

Peeran, Syed Wali; Altaher, Omar Basheer; Peeran, Syed Ali; Alsaid, Fatma Mojtaba; Mugrabi, Marei Hamed; Ahmed, Aisha Mojtaba; Grain, Abdulgader

2014-01-01

Libya is a vast country situated in North Africa, having a relatively better functioning economy with a scanty population. This article is the first known attempt to review the current state of oral health care in Libya and to explore the present trends and future challenges. Libyan health system, oral health care, and human resources with the present status of dental education are reviewed comprehensively. A bibliographic study of oral health research and publications has been carried out. The results point toward a common indicator that oral health-related research is low. Strategies have to be developed to educate the medical and dental professionals, to update the current curriculum and enable the system to be competent in all aspects of oral health care management.

Oral health in Libya: addressing the future challenges

PubMed Central

Peeran, Syed Wali; Altaher, Omar Basheer; Peeran, Syed Ali; Alsaid, Fatma Mojtaba; Mugrabi, Marei Hamed; Ahmed, Aisha Mojtaba; Grain, Abdulgader

2014-01-01

Libya is a vast country situated in North Africa, having a relatively better functioning economy with a scanty population. This article is the first known attempt to review the current state of oral health care in Libya and to explore the present trends and future challenges. Libyan health system, oral health care, and human resources with the present status of dental education are reviewed comprehensively. A bibliographic study of oral health research and publications has been carried out. The results point toward a common indicator that oral health–related research is low. Strategies have to be developed to educate the medical and dental professionals, to update the current curriculum and enable the system to be competent in all aspects of oral health care management. PMID:24666627

Exploring Bim for Operational Integrated Asset Management - a Preliminary Study Utilising Real-World Infrastructure Data

NASA Astrophysics Data System (ADS)

Boyes, G. A.; Ellul, C.; Irwin, D.

2017-10-01

The use of 3D information models within collaborative working environments and the practice of Building Information Modelling (BIM) are becoming more commonplace within infrastructure projects. Currently used predominantly during the design and construction phase, the use of BIM is capable in theory of providing the information at handover that will satisfy the Asset Information Requirements (AIRs) of the future Infrastructure Manager (IM). One particular challenge is establishing a link between existing construction-centric information and the asset-centric information needed for future operations. Crossrail, a project to build a new high-frequency railway underneath London, is handling many such challenges as they prepare to handover their digital information to the future operator, in particular the need to provide a two-way link between a federated 3D CAD model and an object-relational Asset Information Management System (AIMS). This paper focusses on the potential for improved Asset Management (AM) by integrating BIM and GIS systems and practices, and makes a preliminary report on how 3D spatial queries can be used to establish a two-way relational link between two information systems (3D geometry and asset lists), as well as the challenges being overcome to transform the data to be suitable for AM.

Heat supply from municipal solid waste incineration plants in Japan: Current situation and future challenges.

PubMed

Tabata, Tomohiro; Tsai, Peii

2016-02-01

The use of waste-to-energy technology as part of a municipal solid waste management strategy could reduce the use of fossil fuels and contribute to prevention of global warming. In this study, we examined current heat and electricity production by incineration plants in Japan for external use. Herein, we discuss specific challenges to the promotion of heat utilisation and future municipal solid waste management strategies. We conducted a questionnaire survey to determine the actual conditions of heat production by incineration plants. From the survey results, information of about 498 incineration plants was extracted. When we investigated the relationship between heat production for external use and population density where incineration plants were located, we found that regions with a population density <1000 persons (km(2))(-1) produce <500 MJ t(-1) of heat. We also found that external use of such energy for factories, markets, and related use, was noted in cities with a population density of 2000 to 4000 persons (km(2))(-1). Several incineration plants have poor performance for heat production because there are few facilities near them to provide demand for the energy. This is the result of redundant capacity, and is reflected in the heat production performance. Given these results, we discussed future challenges to creating energy demand around incineration plants where there is presently none. We also examined the challenges involved in increasing heat supply beyond the present situation. © The Author(s) 2015.

DOE Office of Scientific and Technical Information (OSTI.GOV)

J. Carmack; L. Braase; F. Goldner

The mission of the Advanced Fuels Campaign (AFC) is to perform Research, Development, and Demonstration (RD&D) activities for advanced fuel forms (including cladding) to enhance the performance and safety of the nation’s current and future reactors, enhance proliferation resistance of nuclear fuel, effectively utilize nuclear energy resources, and address the longer-term waste management challenges. This includes development of a state of the art Research and Development (R&D) infrastructure to support the use of a “goal oriented science based approach.” AFC uses a “goal oriented, science based approach” aimed at a fundamental understanding of fuel and cladding fabrication methods and performancemore » under irradiation, enabling the pursuit of multiple fuel forms for future fuel cycle options. This approach includes fundamental experiments, theory, and advanced modeling and simulation. One of the most challenging aspects of AFC is the management, integration, and coordination of major R&D activities across multiple organizations. AFC interfaces and collaborates with Fuel Cycle Technologies (FCT) campaigns, universities, industry, various DOE programs and laboratories, federal agencies (e.g., Nuclear Regulatory Commission [NRC]), and international organizations. Key challenges are the development of fuel technologies to enable major increases in fuel performance (safety, reliability, power and burnup) beyond current technologies, and development of characterization methods and predictive fuel performance models to enable more efficient development and licensing of advanced fuels. Challenged with the research and development of fuels for two different reactor technology platforms, AFC targeted transmutation fuel development and focused ceramic fuel development for Advanced LWR Fuels.« less

Management of hypoxemic respiratory failure and pulmonary hypertension in preterm infants.

PubMed

Ambalavanan, N; Aschner, J L

2016-06-01

While diagnoses of hypoxemic respiratory failure (HRF) and pulmonary hypertension (PH) in preterm infants may be based on criteria similar to those in term infants, management approaches often differ. In preterm infants, HRF can be classified as 'early' or 'late' based on an arbitrary threshold of 28 postnatal days. Among preterm infants with late HRF, the pulmonary vascular abnormalities associated with bronchopulmonary dysplasia (BPD) represent a therapeutic challenge for clinicians. Surfactant, inhaled nitric oxide (iNO), sildenafil, prostacyclin and endothelin receptor blockers have been used to manage infants with both early and late HRF. However, evidence is lacking for most therapies currently in use. Chronic oral sildenafil therapy for BPD-associated PH has demonstrated some preliminary efficacy. A favorable response to iNO has been documented in some preterm infants with early PH following premature prolonged rupture of membranes and oligohydramnios. Management is complicated by a lack of clear demarcation between interventions designed to manage respiratory distress syndrome, prevent BPD and treat HRF. Heterogeneity in clinical phenotype, pathobiology and genomic underpinnings of BPD pose challenges for evidence-based management recommendations. Greater insight into the spectrum of disease phenotypes represented by BPD can optimize existing therapies and promote development of new treatments. In addition, better understanding of an individual's phenotype, genotype and biomarkers may suggest targeted personalized interventions. Initiatives such as the Prematurity and Respiratory Outcomes Program provide a framework to address these challenges using genetic, environmental, physiological and clinical data as well as large repositories of patient samples.

Polycythemia Vera Management and Challenges in the Community Health Setting

PubMed Central

Gerds, Aaron T.; Dao, Kim-Hien

2017-01-01

Patients with polycythemia vera (PV) experience shortened survival, increased risk of thromboembolic and hemorrhagic events, and burdensome symptoms. For all patients with PV, treatment with aspirin and hematocrit control with phlebotomy are recommended. In addition, patients with high-risk status or poor hematocrit control benefit from cytoreductive therapy with hydroxyurea, although approximately 1 in 4 patients develops resistance or intolerance. For patients who are resistant to or intolerant of hydroxyurea, studies have shown that ruxolitinib, a Janus kinase 1/2 inhibitor, provides hematocrit control, reduces spleen size, normalizes blood counts, and improves PV-related symptoms. For many patients, PV is managed in a community health setting, and it is important that community hematologists, oncologists, and internists are familiar with the contemporary management of PV to improve patient outcomes, including management for patients who present with unique health-care needs. This review provides an overview of current treatment options for patients with PV and discusses challenging circumstances encountered by community providers in the management of PV, including symptom assessment, identification of hydroxyurea resistance/intolerance, pregnancy, elective surgeries, concomitant immunosuppressants, and managing patients in areas with limited access to specialized hematologic care. PMID:28095380

The hidden challenges in role transitions and how leadership coaching can help new leaders find solid ground.

PubMed

Weinstock, Beth

2011-01-01

Leadership coaching is becoming an increasingly important intervention that helps individual nurse executives and managers develop and use the best of their strengths, gifts, and talents. As the need for leadership in nursing becomes urgent and brave souls move into the positions of greater authority and potential impact, they will face challenges as they move up in rank. This article identifies the hidden and often-overlooked challenges that are faced by new leaders as they transition into roles of increased responsibility, and it demonstrates how leadership coaching can help new leaders make successful transitions. As the current health care crisis creates opportunity for new leaders, those who opt for promotions and lateral shifts encounter both expected and surprising challenges. The expected challenges include mastering new content skills, learning new organizational structures, and getting to know new teams. The less obvious stressors include issues of self-esteem, assertiveness, self-consciousness, self-criticism, perfectionism, new boundaries, changing identities, and finding one's own leadership style. These important issues are often kept out of conscious awareness and overlooked at great cost to the individual leader and her institution. Leadership coaching can provide support and practical strategies for managing and overcoming these hidden challenges.

Management in biophotonics and biotechnologies

NASA Astrophysics Data System (ADS)

Meglinski, I. V.; Tuchin, V. V.

2005-10-01

Biophotonics, one of the most exciting and rapidly growing areas, offers vast potential for changing traditional approaches to meeting many critical needs in medicine, biology, pharmacy, food, health care and cosmetic industries. Follow the market trends we developed new MSc course Management in Biophotonics and Biotechnologies (MBB) that provide students of technical disciplines with the necessary training, education and problem-solving skills to produce professionals and managers who are better equipped to handle the challenges of modern science and business in biophotonics and biotechnology. A major advantage of the course is that it provides skills not currently available to graduates in other Master programs.

Management of Herpes Simplex Virus Keratitis in the Pediatric Population.

PubMed

Vadoothker, Saujanya; Andrews, Laura; Jeng, Bennie H; Levin, Moran Roni

2018-05-14

Herpes simplex virus (HSV) keratitis is a highly prevalent and visually-disabling disease in both the pediatric and adult population. While many studies have investigated the treatment of HSV keratitis in adult patients, few have focused on managing this condition in children. Children are at particularly high risk for visual morbidity due to unique challenges in diagnosis and treatment, and the often more aggressive disease course that results in corneal scarring, and subsequently amblyopia. This review presents the pathogenesis and most current recommendations for the medical and surgical management of HSV keratitis in the pediatric population.

Contemporary management of flail chest.

PubMed

Vana, P Geoff; Neubauer, Daniel C; Luchette, Fred A

2014-06-01

Thoracic injury is currently the second leading cause of trauma-related death and rib fractures are the most common of these injuries. Flail chest, as defined by fracture of three or more ribs in two or more places, continues to be a clinically challenging problem. The underlying pulmonary contusion with subsequent inflammatory reaction and right-to-left shunting leading to hypoxia continues to result in high mortality for these patients. Surgical stabilization of the fractured ribs remains controversial. We review the history of management for flail chest alone and when combined with pulmonary contusion. Finally, we propose an algorithm for nonoperative and surgical management.

Ventilatory Management and Extubation Criteria of the Neurological/Neurosurgical Patient

PubMed Central

Souter, M. J.; Manno, Edward M.

2013-01-01

Approximately 200 000 patients per year will require mechanical ventilation secondary to neurological injury or disease. The associated mortality, morbidity, and costs are significant. The neurological patient presents a unique set of challenges to airway management, mechanical ventilation, and defining extubation readiness. Neurological injury and disease can directly or indirectly involve the process involved with respiration or airway control. This article will review the basics of airway management and mechanical ventilation in the neurological patient. The current state of the literature evaluating extubation criteria in the neurological patient will also be reviewed. PMID:23983886

Modeling and managing urban water demand through smart meters: Benefits and challenges from current research and emerging trends

NASA Astrophysics Data System (ADS)

Cominola, A.; Giuliani, M.; Castelletti, A.; Piga, D.; Rizzoli, A. E.

2015-12-01

Urban population growth, climate and land use change are expected to boost residential water demand in urban contexts in the next decades. In such a context, developing suitable demand-side management strategies is essential to meet future water demands, pursue water savings, and reduce the costs for water utilities. Yet, the effectiveness of water demand management strategies (WDMS) relies on our understanding of water consumers' behavior, their consumption habits, and the water use drivers. While low spatial and temporal resolution water consumption data, as traditionally gathered for billing purposes, hardly support this understanding, the advent of high-resolution, smart metering technologies allowed for quasi real-time monitoring water consumption at the single household level. This, in turn, is advancing our ability in characterizing consumers' behavior, modeling, and designing user-oriented residential water demand management strategies. Several water smart metering programs have been rolled-out in the last two decades worldwide, addressing one or more of the following water demand management phases: (i) data gathering, (ii) water end-uses characterization, (iii) user modeling, (iv) design and implementation of personalized WDMS. Moreover, the number of research studies in this domain is quickly increasing and big economic investments are currently being devoted worldwide to smart metering programs. With this work, we contribute the first comprehensive review of more than 100 experiences in the field of residential water demand modeling and management, and we propose a general framework for their classification. We revise consolidated practices, identify emerging trends and highlight the challenges and opportunities for future developments given by the use of smart meters advancing residential water demand management. Our analysis of the status quo of smart urban water demand management research and market constitutes a structured collection of information supporting the development of integrated procedures in the field of urban water management, as well as common actions aiding the collaboration with other sectors, as the nexus with energy demand management.

Acute pancreatitis: current perspectives on diagnosis and management

PubMed Central

Shah, Adarsh P; Mourad, Moustafa M; Bramhall, Simon R

2018-01-01

The last two decades have seen the emergence of significant evidence that has altered certain aspects of the management of acute pancreatitis. While most cases of acute pancreatitis are mild, the challenge remains in managing the severe cases and the complications associated with acute pancreatitis. Gallstones are still the most common cause with epidemiological trends indicating a rising incidence. The surgical management of acute gallstone pancreatitis has evolved. In this article, we revisit and review the methods in diagnosing acute pancreatitis. We present the evidence for the supportive management of the condition, and then discuss the management of acute gallstone pancreatitis. Based on the evidence, our local institutional pathways, and clinical experience, we have produced an outline to guide clinicians in the management of acute gallstone pancreatitis. PMID:29563826

Agricultural Pesticide Management in Thailand: Situation and Population Health Risk

PubMed Central

Panuwet, Parinya; Siriwong, Wattasit; Prapamontol, Tippawan; Ryan, P. Barry; Fiedler, Nancy; Robson, Mark G.; Barr, Dana Boyd

2012-01-01

As an agricultural country and one of the world’s major food exporters, Thailand relies heavily on the use of pesticides to protect crops and increase yields. During the past decade, the Kingdom of Thailand has experienced an approximate four-fold increase in pesticide use. This increase presents a challenge for the Royal Thai Government in effectively managing and controlling pesticide use based upon the current policies and legal infrastructure. We have reviewed several key components for managing agricultural pesticides in Thailand. One of the main obstacles to effective pesticide regulation in Thailand is the lack of a consolidated, uniform system designed specifically for pesticide management. This deficit has weakened the enforcement of existing regulations, resulting in misuse/overuse of pesticides, and consequently, increased environmental contamination and human exposure. This article provides a systematic review of how agricultural pesticides are regulated in Thailand. In addition, we provide our perspectives on the current state of pesticide management, the potential health effects of widespread, largely uncontrolled use of pesticides on the Thai people and ways to improve pesticide management in Thailand. PMID:22308095

Improving the Acquisition and Management of Sample Curation Data

NASA Technical Reports Server (NTRS)

Todd, Nancy S.; Evans, Cindy A.; Labasse, Dan

2011-01-01

This paper discusses the current sample documentation processes used during and after a mission, examines the challenges and special considerations needed for designing effective sample curation data systems, and looks at the results of a simulated sample result mission and the lessons learned from this simulation. In addition, it introduces a new data architecture for an integrated sample Curation data system being implemented at the NASA Astromaterials Acquisition and Curation department and discusses how it improves on existing data management systems.

Leader-Member Exchange Relationships in Health Information Management

PubMed Central

Hunt, T.J.

2014-01-01

This article seeks to raise awareness of the leader-member exchange (LMX) theory of leadership and its potential benefit to the health information management (HIM) profession. A literature review that was conducted identified a leadership challenge for HIM practitioners. The review also provides examples of leadership definitions, and potential benefits of LMX to HIM professionals in leading people and influencing leaders in their organizations. The LMX concept may be an avenue to investigate in preparing future and current HIM professionals for leadership. PMID:24808805

Leader-member exchange relationships in health information management.

PubMed

Hunt, T J

2014-01-01

This article seeks to raise awareness of the leader-member exchange (LMX) theory of leadership and its potential benefit to the health information management (HIM) profession. A literature review that was conducted identified a leadership challenge for HIM practitioners. The review also provides examples of leadership definitions, and potential benefits of LMX to HIM professionals in leading people and influencing leaders in their organizations. The LMX concept may be an avenue to investigate in preparing future and current HIM professionals for leadership.

Diagnosis and management of patients with clefts: a comprehensive and interdisciplinary approach.

PubMed

Hartzell, Larry D; Kilpatrick, Lauren A

2014-10-01

This article reviews the most current practice guidelines in the diagnosis and management of patients born with cleft lip and/or palate. Such patients frequently have multiple medical and social issues that benefit greatly from a team approach. Common challenges include feeding difficulty, nutritional deficiency, speech disorders, hearing problems, ear disease, dental anomalies, and both social and developmental delays, among others. Interdisciplinary evaluation and collaboration throughout a patient's development are essential. Copyright © 2014 Elsevier Inc. All rights reserved.

Managing Current Developments in SEN and Inclusion: Developing Confidence in New Teachers

ERIC Educational Resources Information Center

Richards, Gill

2010-01-01

Developments in special and inclusive education have lead to increasing challenges for teachers. Initial Teacher Education has struggled to keep pace with these developments and equip all newly qualified teachers with the skills required to meet the needs of children with SEN. This paper reflects upon recent national initiatives designed to…

The state of the system and steps toward resilience of distrubance-dependent oak forests

Treesearch

Tricia G. Knoot; Lisa A. Schulte; John C. Tyndall; Brian J. Palik

2010-01-01

Current ecological, economic, and social conditions present unique challenges to natural resource managers seeking to maintain the resilience of disturbance-dependent ecosystems, such as oak (Quercus spp.) forests. Oak-dominated ecosystems throughout the U.S. have historically been perpetuated through periodic disturbance, such as fire, but more...

The Interpretation of Problem Based Learning: A Case Study

ERIC Educational Resources Information Center

Li, Huichun

2013-01-01

Currently, there are a large number of higher education institutions transforming their traditional educational approaches to PBL. In order to address the challenges for PBL implementation for a university, it is quite necessary to investigate how the managers and staff members interpret PBL in practice. Through the exploration of a university…

Managing Water Quality in Wetlands with Foresty BMP's

Treesearch

Bob Rummer

2004-01-01

Forested wetlands are uniquely critical areas in forest operations that present special challenges to protect water quality. These locations are a direct interface between the impacts of forest operations and water. BMP's are designed to minimize nonpoint source pollution, but much of the science behind current guidelines is based on an understanding of erosion...

The Age of the Network: Organizing Principles for the 21st Century.

ERIC Educational Resources Information Center

Lipnack, Jessica; Stamps, Jeffrey

A practical view is offered to leaders, managers, and teams of how to think about their companies and reinvent them without losing the value and knowledge embedded in their current organization. Organizations can break through challenges and recognize entirely new business opportunities through the creation of interlocking, boundary-crossing…

Insulin resistance, role of metformin and other noninsulin therapies in pediatric type 1 diabetes

USDA-ARS?s Scientific Manuscript database

Type 1 diabetes mellitus (T1DM) in youth is a challenging chronic medical condition. Its management should address not only the glycemic control but also insulin resistance and cardiovascular disease risk factors which are increasingly recognized to be present in youth with TID. Current knowledge on...

Using Education to Bring Climate Change Adaptation to Pacific Communities

ERIC Educational Resources Information Center

Vize, Sue

2012-01-01

Traditional communities remain a dominant feature in the Pacific and are key players in land and sea management. Fostering improved climate literacy is therefore essential to equip communities to respond to the current and future challenges posed by climate change in the region. Increased understanding and development of skills to respond to the…

Federated Security: The Shibboleth Approach

ERIC Educational Resources Information Center

Morgan, R. L.; Cantor, Scott; Carmody, Steven; Hoehn, Walter; Klingenstein, Ken

2004-01-01

The Fifth Annual Educause Current Issues Survey ranked "security and identity management" near the top of the list of critical IT challenges on campus today. Recognition of the crucial importance of securing networked resources led Internet2 to establish its Middleware Initiative (I2MI) in 1999. While Internet2 was founded to develop and deploy…

Social Empowerment in Mexican Violent Contexts through Media Competence

ERIC Educational Resources Information Center

Grijalva-Verdugo, Abel-Antonio; Moreno-Candil, David

2017-01-01

The acquisition of digital skills, media diet management, and general knowledge of ICT, is essential for the development and empowerment of audiences in the current media ecology, particularly considering the political and social challenges of the Latin American environment. In that sense, the study of media competence is urgent for sizing up the…

An Integrated Customer Knowledge Management Framework for Academic Libraries

ERIC Educational Resources Information Center

Daneshgar, Farhad; Parirokh, Mehri

2012-01-01

The ability of academic libraries to produce timely and effective responses to various environmental changes constitutes a major challenge for them to enhance their survival rate and maintain growth in competitive environments. This article provides a conceptual model as an analytical tool for both improving current services as well as creating…

Comparative transcriptomics of genetically divergent lines of chickens in response to Marek’s disease virus challenge at cytolytic phase

USDA-ARS?s Scientific Manuscript database

Marek’s disease (MD) remains an economically significant threat to poultry industry worldwide. Genetic resistance to MD is a promising alternative strategy to augment current control measures (vaccination and management). However, only a few functional genes reportedly conferring MD resistance have ...

Five Recession-Driven Strategies for Planning and Managing Campus Facilities

ERIC Educational Resources Information Center

Rudden, Michael S.

2010-01-01

Colleges and universities continue to face significant fiscal challenges in the current recession. A review of ongoing campus facilities planning projects, coupled with a review of more than 30 recent campus master planning requests for proposals and the relevant literature, indicates that colleges and universities are finding innovative ways to…

Current Concepts in Sports-related Concussion.

PubMed

Feden, Jeffrey P

2016-10-04

Increasing concern over the acute and long-term consequences of sports-related concussion has generated widespread interest and attention. This article provides an overview of concussion in athletes, including diagnostic and management considerations, and highlights the clinical challenges associated with repeated minor head trauma in sports. [Full article available at http://rimed.org/rimedicaljournal-2016-10.asp].

76 FR 44593 - Identifying the Center for Drug Evaluation and Research's Science and Research Needs...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... . Submit written comments to the Division of Dockets Management (HFA-305), Food and Drug Administration... from CDER's offices were asked to identify: (1) Scientific challenges currently addressed on a case-by-case basis that might benefit from the development of a systematized approach; (2) recurrent science...

The science of firescapes: Achieving fire-resilient communities

Treesearch

Alistair M. S. Smith; Crystal A. Kolden; Travis B. Paveglio; Mark A. Cochrane; David MJS Bowman; Max A. Moritz; Andrew D. Kliskey; Lilian Alessa; Andrew T. Hudak; Chad M. Hoffman; James A. Lutz; Lloyd P. Queen; Scott J. Goetz; Philip E. Higuera; Luigi Boschetti; Mike Flannigan; Kara M. Yedinak; Adam C. Watts; Eva K. Strand; Jan W. van Wagtendonk; John W. Anderson; Brian J. Stocks; John T. Abatzoglou

2016-01-01

Wildland fire management has reached a crossroads. Current perspectives are not capable of answering interdisciplinary adaptation and mitigation challenges posed by increases in wildfire risk to human populations and the need to reintegrate fire as a vital landscape process. Fire science has been, and continues to be, performed in isolated "silos," including...

Using the Personal Competence Manager as a Complementary Approach to IMS Learning Design Authoring

ERIC Educational Resources Information Center

Vogten, Hubert; Koper, Rob; Martens, Harrie; van Bruggen, Jan

2008-01-01

In this article TENCompetence will be presented as a framework for lifelong competence development. More specifically, the relationship between the TENCompetence framework and the IMS Learning Design (LD) specification is explored. LD authoring has proven to be challenging and the toolset currently available is targeting expert users mostly…

Teaching the Google-Eyed YouTube Generation

ERIC Educational Resources Information Center

Ashraf, Bill

2009-01-01

Purpose: The purpose of this paper is to report on how the University sector in the UK has undertaken a massive transformation over recent years, resulting in a current mass market. Institutions (and their managers) are facing enormous challenges to establish competitive advantages whilst attending to customer need and focus. A smarter,…

Making the link between health and productivity at the workplace--a global perspective.

PubMed

Kirsten, Wolf

2010-01-01

This paper discusses the relationship between health and productivity at the workplace by providing a global perspective of the current status of the fields of workplace health promotion and health management. The prevailing chronic disease trends coupled with economic pressures have proven a significant challenge for employers and employees alike. While a global growth trend in workplace health promotion can be observed the number of companies which take a proactive and integrated approach to workplace health remains small. Workplace health promotion programs in the United States typically focus on the individual health risks of employees while their European counterparts target work-related hazards, physical and, more recently, psychosocial. A number of specific tools and programs for integrated health management are described, such as self-report instruments to measure presenteeism. The analysis suggests that existing occupational health services strategies are insufficient to address the current challenges. Improved employee health can only be achieved in a sustainable manner when integrating all health-related services within an enterprise and addressing psychosocial and organizational factors as well as individual health issues.

CLOSURE OF LARYNGECTOMY DEFECTS IN THE AGE OF CHEMORADIATION THERAPY

PubMed Central

Hanasono, Matthew M.; Lin, Derrick; Wax, Mark K.

2014-01-01

The use of chemoradiation therapy in laryngeal cancer has resulted in significant reconstructive challenges. Although reconstruction of salvage laryngectomy defects remains controversial, current literature supports aggressive management of these defects with vascularized tissue, even when there is sufficient pharyngeal tissue present for primary closure. Significant advancement in reconstructive techniques has permitted improved outcomes in patients with advanced disease who require total laryngopharyngectomy or total laryngoglossectomy. Use of enteric and fasciocutaneous flaps result in good patient outcomes. Finally, wound complication rates after salvage surgery approach 60% depending on comorbid conditions such as cardiac insufficiency, hypothyroidism, or extent of previous treatment. Neck dehiscence, great vessel exposure, fistula formation, or cervical skin necrosis results in complex wounds that can often be treated initially with negative pressure dressings followed by definitive reconstruction. The timing of repair and approach to the vessel-depleted neck also present challenges in this patient population. Currently, there is significant institutional bias in the management of the patient with postchemoradiation salvage laryngectomy. Future prospective multi-institutional studies are certainly needed to more clearly define optimal treatment of these difficult patients. PMID:21416549

Non-operative management of a complete anterior cruciate ligament injury in an English Premier League football player with return to play in less than 8 weeks: applying common sense in the absence of evidence

PubMed Central

Weiler, Richard; Monte-Colombo, Mathew; Mitchell, Adam; Haddad, Fares

2015-01-01

This case report illustrates and discusses the non-operative management of a complete anterior cruciate ligament (ACL) injury in an English Premier League football player, his return to play within 8 weeks and problem-free follow-up at 18 months post injury. When non-operative verses surgical ACL reconstruction is considered there are many fundamental gaps in our knowledge and currently, at elite level, there are no cases in cutting sports within the literature to guide these decisions. When the norm is for all professional footballers to be recommended surgery, it will be very challenging when circumstances and patient autonomy dictate a conservative approach, where prognosis, end points and risk are unclear and assumed to be high. This case challenges current dogma and provides a starting point for much needed debate about best practice, treatment options, research direction and not just at the elite level of sport. PMID:25917066

The Diagnostic Challenge Competition: Probabilistic Techniques for Fault Diagnosis in Electrical Power Systems

NASA Technical Reports Server (NTRS)

Ricks, Brian W.; Mengshoel, Ole J.

2009-01-01

Reliable systems health management is an important research area of NASA. A health management system that can accurately and quickly diagnose faults in various on-board systems of a vehicle will play a key role in the success of current and future NASA missions. We introduce in this paper the ProDiagnose algorithm, a diagnostic algorithm that uses a probabilistic approach, accomplished with Bayesian Network models compiled to Arithmetic Circuits, to diagnose these systems. We describe the ProDiagnose algorithm, how it works, and the probabilistic models involved. We show by experimentation on two Electrical Power Systems based on the ADAPT testbed, used in the Diagnostic Challenge Competition (DX 09), that ProDiagnose can produce results with over 96% accuracy and less than 1 second mean diagnostic time.

Reforming funding for chronic illness: Medicare-CDM.

PubMed

Swerissen, Hal; Taylor, Michael J

2008-02-01

Chronic diseases are a major challenge for the Australian health care system in terms of both the provision of quality care and expenditure, and these challenges will only increase in the future. Various programs have been instituted under the Medicare system to provide increased funding for chronic care, but essentially these programs still follow the traditional fee-for-service model. This paper proposes a realignment and extension of current Medicare chronic disease management programs into a framework that provides general practitioners and other health professionals with the necessary "tools" for high quality care planning and ongoing management, and incorporating international models of outcome-linked funding. The integration of social support services with the Medicare system is also a necessary step in providing high quality care for patients with complex needs requiring additional support.

Roles and challenges of the health information management educator: a national HIM faculty survey.

PubMed

Houser, Shannon H; Tesch, Linde; Hart-Hester, Susan; Dixon-Lee, Claire

2009-01-01

Health information technology initiatives created the framework for a national health information infrastructure that concomitantly fostered a need to build intellectual capacity within our current and future health information management (HIM) work force. Results from the 2008 HIM Educator Survey are discussed. Developed for voluntary electronic participation, the survey comprised a series of questions about educators' professional interests and responsibilities. Summary data from the 402 respondents are provided and highlight areas such as academic rank, teaching status, salary range, levels of interest in various issues, and use of virtual learning tools. Data from this survey provide insights into the concerns and challenges many HIM educators face in today's training institutions and suggest implications for future directions in work force training and professional development within the HIM field.

Meeting report: Ocean 'omics science, technology and cyberinfrastructure: current challenges and future requirements (August 20-23, 2013).

PubMed

Gilbert, Jack A; Dick, Gregory J; Jenkins, Bethany; Heidelberg, John; Allen, Eric; Mackey, Katherine R M; DeLong, Edward F

2014-06-15

The National Science Foundation's EarthCube End User Workshop was held at USC Wrigley Marine Science Center on Catalina Island, California in August 2013. The workshop was designed to explore and characterize the needs and tools available to the community that is focusing on microbial and physical oceanography research with a particular emphasis on 'omic research. The assembled researchers outlined the existing concerns regarding the vast data resources that are being generated, and how we will deal with these resources as their volume and diversity increases. Particular attention was focused on the tools for handling and analyzing the existing data, on the need for the construction and curation of diverse federated databases, as well as development of shared, interoperable, "big-data capable" analytical tools. The key outputs from this workshop include (i) critical scientific challenges and cyber infrastructure constraints, (ii) the current and future ocean 'omics science grand challenges and questions, and (iii) data management, analytical and associated and cyber-infrastructure capabilities required to meet critical current and future scientific challenges. The main thrust of the meeting and the outcome of this report is a definition of the 'omics tools, technologies and infrastructures that facilitate continued advance in ocean science biology, marine biogeochemistry, and biological oceanography.

Meeting report: Ocean ‘omics science, technology and cyberinfrastructure: current challenges and future requirements (August 20-23, 2013)

PubMed Central

Gilbert, Jack A; Dick, Gregory J.; Jenkins, Bethany; Heidelberg, John; Allen, Eric; Mackey, Katherine R. M.

2014-01-01

The National Science Foundation’s EarthCube End User Workshop was held at USC Wrigley Marine Science Center on Catalina Island, California in August 2013. The workshop was designed to explore and characterize the needs and tools available to the community that is focusing on microbial and physical oceanography research with a particular emphasis on ‘omic research. The assembled researchers outlined the existing concerns regarding the vast data resources that are being generated, and how we will deal with these resources as their volume and diversity increases. Particular attention was focused on the tools for handling and analyzing the existing data, on the need for the construction and curation of diverse federated databases, as well as development of shared, interoperable, “big-data capable” analytical tools. The key outputs from this workshop include (i) critical scientific challenges and cyber infrastructure constraints, (ii) the current and future ocean ‘omics science grand challenges and questions, and (iii) data management, analytical and associated and cyber-infrastructure capabilities required to meet critical current and future scientific challenges. The main thrust of the meeting and the outcome of this report is a definition of the ‘omics tools, technologies and infrastructures that facilitate continued advance in ocean science biology, marine biogeochemistry, and biological oceanography. PMID:25197495

Learning Agents for Autonomous Space Asset Management (LAASAM)

NASA Astrophysics Data System (ADS)

Scally, L.; Bonato, M.; Crowder, J.

2011-09-01

Current and future space systems will continue to grow in complexity and capabilities, creating a formidable challenge to monitor, maintain, and utilize these systems and manage their growing network of space and related ground-based assets. Integrated System Health Management (ISHM), and in particular, Condition-Based System Health Management (CBHM), is the ability to manage and maintain a system using dynamic real-time data to prioritize, optimize, maintain, and allocate resources. CBHM entails the maintenance of systems and equipment based on an assessment of current and projected conditions (situational and health related conditions). A complete, modern CBHM system comprises a number of functional capabilities: sensing and data acquisition; signal processing; conditioning and health assessment; diagnostics and prognostics; and decision reasoning. In addition, an intelligent Human System Interface (HSI) is required to provide the user/analyst with relevant context-sensitive information, the system condition, and its effect on overall situational awareness of space (and related) assets. Colorado Engineering, Inc. (CEI) and Raytheon are investigating and designing an Intelligent Information Agent Architecture that will provide a complete range of CBHM and HSI functionality from data collection through recommendations for specific actions. The research leverages CEI’s expertise with provisioning management network architectures and Raytheon’s extensive experience with learning agents to define a system to autonomously manage a complex network of current and future space-based assets to optimize their utilization.

Global risk & global challenges - Space as a game changer for socioeconomic sustainable development

NASA Astrophysics Data System (ADS)

Lehnert, Christopher; Karlsson, Evelina; Giannopapa, Christina

2017-11-01

The world's societies at the beginning of the 21st century are better off than ever before. (Gapminder, 2015) At the same time, the world is also threatened by global challenges where space as a tool has and can play a pivotal role in meeting those challenges. The challenges range from climate change, over mass unemployment, to terrorism or migration - to name but a few. Space activities have started to respond to this changing world, not only by providing a deeper understanding of our universe, but by using space as an additional sphere and sector, through which humankind can increase and secure its wealth - it is thus game changing in the way we sustain humanity's existence. This paper is meant to capture this development. In the first part, an overview is given on the risks that humankind is facing. The second part describes the way that space can be used as a tool to prevent and manage these risks. The overview in the first part is based on the examination of the most recent reports and overall strategies of key International Governmental Organisations and Non-Governmental Organisations that are involved in agenda-setting, policy formulation and implementation. The second part includes an overview on current activities of the European Space Agency (ESA) that play a role in responding to these risks. To better understand ESA's activities that contain humanity's risks, a standard classification for risks management is used, which distinguishes between four components: Identification, Assessment, Management and Communication (Renn, 2005). The analysis reveals how space activities already today play a pivotal role in all four types of risk management. Space activities contribute very tangible to the management of risks through its space mission, but also in a more indirect way, as providing the technical backbone for stable and reliable cooperation in the international governance arena, and serve as crucial economic stimulator. The overall results show that space activities touch upon every aspect of responding to the humanity's risks. Especially in the identification and the preventive management of humanity's risks, space systems are a crucial enabler. They are also an important part in dealing with risks related to scarcity of resources. It is thus important that current levels of investments into space infrastructure are maintained, as the benefits of space activities is essential to humankind's existence and that upon further programmatic decisions, stakeholders involved with the management of risks are being consulted.

Mars Reconnaissance Orbiter Mission: Systems Engineering Challenges on the Mars Reconnaissance Orbiter Mission

NASA Technical Reports Server (NTRS)

Havens, Glen G.

2007-01-01

MRO project is a system of systems requiring system engineering team to architect, design, integrate, test, and operate these systems at each level of the project. The challenge of system engineering mission objectives into a single mission architecture that can be integrated tested, launched, and operated. Systems engineering must translate high-level requirements into integrated mission design. Systems engineering challenges were overcome utilizing a combination by creative designs built into MRO's flight and ground systems: a) Design of sophisticated spacecraft targeting and data management capabilities b) Establishment of a strong operations team organization; c) Implementation of robust operational processes; and d) Development of strategic ground tools. The MRO system has met the challenge of its driving requirements: a) MRO began its two-year primary science phase on November 7, 2006, and by July 2007, met it minimum requirement to collect 15 Tbits of data after only eight months of operations. Currently we have collected 22 Tbits. b) Based on current performance, mission data return could return 70 Tbits of data by the end of the primary science phase in 2008.

Measuring Property Management Risk and Loss: Step One Toward Managing Property on a Foundation of Risk, Cost, and Benefit

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johnson, Curtis

1999-05-17

This is a period of ever-tightening defense budgets and continuing pressure on the public sector to be more commercial-like, Property policies, practices, and regulations are increasingly being challenged and changed. In these times, we must be leaders in understanding and defining the value of our profession from a commercial standpoint so that we can provide the right services to our customers and explain and defend the value of those services. To do so, we must step outside current property management practices, regulations, and oversight. We must learn to think and speak in the language of those who fund us--a financialmore » language of risk, cost, and benefit. Regardless of regulation and oversight, our bosses are demanding that we demonstrate (financially) the benefits of current practice, or else. This article is intended to be the beginning of an effort to understand and define our profession in terms of risk, cost, and benefit so that we can meet these new challenges. The first step in this effort must be defining and measuring risk, cost, and benefit. Our costs, although sometimes difficult to capture, are easy to understand: they are almost exclusively the effort, both within and without the property management organization, involved in managing property. Unfortunately, property risks and benefits are not so simple or so well understood. Generally, risks and benefits are identified and measured through physical inventory results: potential and actual shortages. This paper will explore the weaknesses in the current understanding and use of shortage information as the yardstick for property management risks and performance. It will define a new framework for understanding the purpose and value of property management. And finally, it will set a course for a new method of measuring and valuing physical inventoty shortages. This new method will yield accurate and useful measures of property management risk and benefit. Once risk and benefit are accurately understood and measured, it will be possible to evaluate, adjust, and explain property management practices and regulations from a commercial, financial perspective; it will be possible for us to be the leaders in redefining the purpose and value of the property management profession for today's environment.« less

Systemic lupus erythematosus diagnosis and management.

PubMed

Thong, Bernard; Olsen, Nancy J

2017-04-01

SLE presents many challenges for clinicians. The onset of disease may be insidious, with many different symptoms and signs, making early and accurate diagnosis challenging. Tests for SLE in the early stages lack specificity; those that are useful later often appear only after organ damage is manifest. Disease patterns are highly variable; flares are not predictable and not always associated with biomarkers. Children with SLE may have severe disease and present special management issues. Older SLE patients have complicating co-morbid conditions. Therapeutic interventions have improved over recent decades, but available drugs do not adequately control disease in many patients, and successful outcomes are limited by off-target effects; some of these become manifest with longer duration of treatment, now in part revealed by improved rates of survival. Despite all of these challenges, advances in understanding the biological basis of SLE have translated into more effective approaches to patient care. This review considers the current state of SLE diagnosis and management, with a focus on new approaches and anticipated advances. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Comparative assessment of municipal sewage sludge incineration, gasification and pyrolysis for a sustainable sludge-to-energy management in Greece

DOE Office of Scientific and Technical Information (OSTI.GOV)

Samolada, M.C.; Zabaniotou, A.A., E-mail: azampani@auth.gr

2014-02-15

Highlights: • The high output of MSS highlights the need for alternative routes of valorization. • Evaluation of 3 sludge-to-energy valorisation methods through SWOT analysis. • Pyrolysis is an energy and material recovery process resulting to ‘zero waste’. • Identification of challenges and barriers for MSS pyrolysis in Greece was investigated. • Adopters of pyrolysis systems face the challenge of finding new product markets. - Abstract: For a sustainable municipal sewage sludge management, not only the available technology, but also other parameters, such as policy regulations and socio-economic issues should be taken in account. In this study, the current statusmore » of both European and Greek Legislation on waste management, with a special insight in municipal sewage sludge, is presented. A SWOT analysis was further developed for comparison of pyrolysis with incineration and gasification and results are presented. Pyrolysis seems to be the optimal thermochemical treatment option compared to incineration and gasification. Sewage sludge pyrolysis is favorable for energy savings, material recovery and high added materials production, providing a ‘zero waste’ solution. Finally, identification of challenges and barriers for sewage sludge pyrolysis deployment in Greece was investigated.« less

Insecticide Resistance in Areas under Investigation by the International Centers of Excellence for Malaria Research: A Challenge for Malaria Control and Elimination

PubMed Central

Quiñones, Martha L.; Norris, Douglas E.; Conn, Jan E.; Moreno, Marta; Burkot, Thomas R.; Bugoro, Hugo; Keven, John B.; Cooper, Robert; Yan, Guiyun; Rosas, Angel; Palomino, Miriam; Donnelly, Martin J.; Mawejje, Henry D.; Eapen, Alex; Montgomery, Jacqui; Coulibaly, Mamadou B.; Beier, John C.; Kumar, Ashwani

2015-01-01

Scale-up of the main vector control interventions, residual insecticides sprayed on walls or structures and/or impregnated in bed nets, together with prompt diagnosis and effective treatment, have led to a global reduction in malaria transmission. However, resistance in vectors to almost all classes of insecticides, particularly to the synthetic pyrethroids, is posing a challenge to the recent trend of declining malaria. Ten International Centers of Excellence for Malaria Research (ICEMR) located in the most malaria-endemic regions of the world are currently addressing insecticide resistance in the main vector populations, which not only threaten hope for elimination in malaria-endemic countries but also may lead to reversal where notable reductions in malaria have been documented. This communication illustrates the current status of insecticide resistance with a focus on the countries where activities are ongoing for 9 out of the 10 ICEMRs. Most of the primary malaria vectors in the ICEMR countries exhibit insecticide resistance, albeit of varying magnitude, and spanning all mechanisms of resistance. New alternatives to the insecticides currently available are still to be fully developed for deployment. Integrated vector management principles need to be better understood and encouraged, and viable insecticide resistance management strategies need to be developed and implemented. PMID:26259947

Therapeutic challenges in renal cell carcinoma

PubMed Central

Penticuff, Justin C; Kyprianou, Natasha

2015-01-01

Renal cell carcinoma (RCC) is a malignancy that in advanced disease, is highly resistant to systemic therapies. Elucidation of the angiogenesis pathways and their intrinsic signaling interactions with the genetic and metabolic disturbances within renal cell carcinoma variants has ushered in the era of “targeted therapies”. Advanced surgical interventions and novel drugs targeting VEGF and mTOR, have improved patient survival and prolonged clinically stable-disease states. This review discusses the current understanding of diagnostic challenges and the mechanism-based clinical evidence on therapeutic management of advanced RCC. PMID:26309897

Astrophysics and Cosmology: International Partnerships

NASA Astrophysics Data System (ADS)

Blandford, Roger

2016-03-01

Most large projects in astrophysics and cosmology are international. This raises many challenges including: --Aligning the sequence of: proposal, planning, selection, funding, construction, deployment, operation, data mining in different countries --Managing to minimize cost growth through reconciling different practices --Communicating at all levels to ensure a successful outcome --Stabilizing long term career opportunities. There has been considerable progress in confronting these challenges. Lessons learned from past collaborations are influencing current facilities but much remains to be done if we are to optimize the scientific and public return on the expenditure of financial and human resources.

The challenge of archiving and preserving remotely sensed data

USGS Publications Warehouse

Faundeen, John L.

2003-01-01

Few would question the need to archive the scientific and technical (S&T) data generated by researchers. At a minimum, the data are needed for change analysis. Likewise, most people would value efforts to ensure the preservation of the archived S&T data. Future generations will use analysis techniques not even considered today. Until recently, archiving and preserving these data were usually accomplished within existing infrastructures and budgets. As the volume of archived data increases, however, organizations charged with archiving S&T data will be increasingly challenged (U.S. General Accounting Office, 2002). The U.S. Geological Survey has had experience in this area and has developed strategies to deal with the mountain of land remote sensing data currently being managed and the tidal wave of expected new data. The Agency has dealt with archiving issues, such as selection criteria, purging, advisory panels, and data access, and has met with preservation challenges involving photographic and digital media. That experience has allowed the USGS to develop management approaches, which this paper outlines.

Challenges and Perspectives for Tertiary Level Hospitals in Bolivia: The case of Santa Cruz de La Sierra Department.

PubMed

Medici, André

2015-01-01

Current legislation transferred public tertiary hospitals in Bolivia from the Municipalities to the Regional Level. However, the Regional Governments are experiencing technical and financial constraints to reform infrastructure, modernize equipment and introduce reforms to allow better governance, management and sustainability of these hospitals. This articles summarizes the recent experience of the Government of Santa Cruz de la Sierra in Bolivia where five tertiary hospitals and blood bank (most of them in precarious working conditions) has been transferred in 2012 from the Municipal Government of Santa Cruz (the capital) to the Regional Government of Santa Cruz. To face the challenges, the Regional Government of Santa Cruz implement several improvements, such as contract new clinical and administrative personal, increases hospital budgetary autonomy, outsource hospitals' auxiliary services, take measures to eliminate waiting lists and make several new investments to modernize and equip the hospitals. The World Bank was contracted to evaluated the future financial sustainability of these investments and to advice the Government to propose changes to increase the hospitals' management performance. The article describes the remaining challenges in these hospitals and the proposals from the World Bank Study. In the area of quality of care, the main challenge is to improve client satisfaction and continuous outcomes monitoring and evaluation according quality standards. In the area of financing, the challenge is how to assure the sustainability of these hospitals with the current level of health financing and the insufficient financial transfers from the National Government. In the area of Governance, reforms to streamline and simplify internal processes need to be introduced in order to establish mechanisms to increase transparency and accountability, allowing the hospital to have a good administration and adequate participation of the main actors in the guidance of the institution.

Risk management abilities in multimodal maritime supply chains: Visibility and control perspectives.

PubMed

Vilko, Jyri; Ritala, Paavo; Hallikas, Jukka

2016-11-29

Supply chain complexity and disintegration lead to increased uncertainty from a stakeholders' perspective, which is emerging as one of the major challenges of risk management. The ability to identify risks has weakened, as the responsibility of supply chain risk management is handed over to outside service providers. Regardless, the risks, their visibility and their impact depend on the position of the companies in the supply chain. The actors in the chain must therefore collaborate to create effective risk management conditions. This challenging situation is especially pronounced in multimodal maritime supply chains, where the risks and actor focality are high. This paper contributes to current risk management literature by providing a holistic and systemic view of risk visibility and control in maritime supply chains. The study employs broad-based, qualitative interview data collected from actors operating in southern Finland and the Gulf of Finland as well as an expert-panel assessment of the related risk management abilities. The results show a high level of variance in the level of risk identification and visibility between the actors in question. This further suggests that collaboration in supply chain risk management is essential, as an awareness of the risks and their control mechanisms do not necessarily reside in the same company. Copyright © 2016 Elsevier Ltd. All rights reserved.

Engineering for reliability in at-home chronic disease management

PubMed Central

Kendall, Logan; Eschler, Jordan; Lozano, Paula; McClure, Jennifer B.; Vizer, Lisa M.; Ralston, James D.; Pratt, Wanda

2014-01-01

Individuals with chronic conditions face challenges with maintaining lifelong adherence to self-management activities. Although reminders can help support the cognitive demands of managing daily and future health tasks, we understand little of how they fit into people’s daily lives. Utilizing a maximum variation sampling method, we interviewed and compared the experiences of 20 older adults with diabetes and 19 mothers of children with asthma to understand reminder use for at-home chronic disease management. Based on our participants’ experiences, we contend that many self-management failures should be viewed as systems failures, rather than individual failures and non-compliance. Furthermore, we identify key principles from reliability engineering that both explain current behavior and suggest strategies to improve patient reminder systems. PMID:25954384

Engineering for reliability in at-home chronic disease management.

PubMed

Kendall, Logan; Eschler, Jordan; Lozano, Paula; McClure, Jennifer B; Vizer, Lisa M; Ralston, James D; Pratt, Wanda

2014-01-01

Individuals with chronic conditions face challenges with maintaining lifelong adherence to self-management activities. Although reminders can help support the cognitive demands of managing daily and future health tasks, we understand little of how they fit into people's daily lives. Utilizing a maximum variation sampling method, we interviewed and compared the experiences of 20 older adults with diabetes and 19 mothers of children with asthma to understand reminder use for at-home chronic disease management. Based on our participants' experiences, we contend that many self-management failures should be viewed as systems failures, rather than individual failures and non-compliance. Furthermore, we identify key principles from reliability engineering that both explain current behavior and suggest strategies to improve patient reminder systems.

Airway Problems in Neonates—A Review of the Current Investigation and Management Strategies

PubMed Central

Mok, Quen

2017-01-01

Airway problems in the neonatal population are often life threatening and raise challenging issues in diagnosis and management. The airway problems can result from congenital or acquired lesions and can be broadly classified into those causing obstruction or those due to an abnormal “communication” in the airway. Many different investigations are now available to identify the diagnosis and quantify the severity of the problem, and these tests can be simple or invasive. Bronchography and bronchoscopy are essential to determine the extent and severity of the airway problem and to plan treatment strategy. Further imaging techniques help to delineate other commonly associated abnormalities. Echocardiography is also important to confirm any associated cardiac abnormality. In this review, the merits and disadvantages of the various investigations now available to the clinician will be discussed. The current therapeutic strategies are discussed, and the review will focus on the most challenging conditions that cause the biggest management conundrums, specifically laryngotracheal cleft, congenital tracheal stenosis, and tracheobronchomalacia. Management of acquired stenosis secondary to airway injury from endotracheal intubation will also be discussed as this is a common problem. Slide tracheoplasty is the preferred surgical option for long-segment tracheal stenosis, and results have improved significantly. Stents are occasionally required for residual or recurrent stenosis following surgical repair. There is sufficient evidence that a multidisciplinary team approach for managing complex airway issues provides the best results for the patient. There is ongoing progress in the field with newer diagnostic tools as well as development of innovative management techniques, such as biodegradable stents and stem cell-based tracheal transplants, leading to a much better prognosis for these children in the future. PMID:28424763

What are the current challenges of managing cancer pain and could digital technologies help?

PubMed

Adam, Rosalind; de Bruin, Marijn; Burton, Christopher David; Bond, Christine M; Giatsi Clausen, Maria; Murchie, Peter

2018-06-01

Pain remains a problem for people with cancer despite effective treatments being available. We aimed to explore current pain management strategies used by patients, caregivers and professionals and to investigate opportunities for digital technologies to enhance cancer pain management. A qualitative study comprising semistructured interviews and focus groups. Patients with cancer pain, their caregivers and health professionals from Northeast Scotland were recruited from a purposive sample of general practices. Professionals were recruited from regional networks. Fifty one participants took part in 33 interviews (eight patients alone, six patient/caregiver dyads and 19 professionals) and two focus groups (12 professionals). Living with cancer was hard work for patients and caregivers and comparable to a 'full-time job'. Patients had personal goals which involved controlling pain intensity and balancing this with analgesic use, side effects, overall symptom burden and social/physical activities.Digital technologies were embraced by most patients, and made living life with advanced cancer easier and richer (eg, video calls with family). Technology was underutilised for pain and symptom management. There were suggestions that technology could support self-monitoring and communicating problems to professionals, but patients and professionals were concerned about technological monitoring adding to the work of managing illness. Cancer pain management takes place in the context of multiple, sometimes competing personal goals. It is possible that technology could be used to help patients share individual symptom experiences and goals, thus enhancing tailored care. The challenge is for digital solutions to add value without adding undue burden. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Metallic stents in the management of ureteric strictures

PubMed Central

Kulkarni, Ravi

2014-01-01

Management of ureteric strictures is a challenging task. Subtle presentation, silent progression and complex aetiology may delay diagnosis. A wide range of available treatment options combined with the lack of adequate randomised trials has led to the introduction of personal bias in the management of this difficult group of patients. Metallic ureteric stents offer an alternative to the conventional treatment modalities. A review of the currently available metallic stents and their role in the long-term management of ureteric strictures is presented. Materials used in the manufacture of indwelling urological devices are evolving all the time. Improved endo-urological techniques combined with new devices made from better compounds will continue to improve patient experience. PMID:24497686

Requirements of supply chain management in differentiating European pork chains.

PubMed

Trienekens, Jacques; Wognum, Nel

2013-11-01

This paper summarizes results obtained by research into pork chain management in the EU Integrated Project Q-Porkchains. Changing demands for intrinsic and extrinsic quality attributes of pork products impact the way supply chain management should be organized from the farmer down to the consumer. The paper shows the importance of Quality Management Systems for integrating supply chains and enhancing consumer confidence. The paper also presents innovations in information system integration for aligning information exchange in the supply chain and logistics concepts based on innovative measurement technologies at the slaughterhouse stage. In the final section research challenges towards sustainable pork supply chains satisfying current consumer demands are presented. Copyright © 2013 Elsevier Ltd. All rights reserved.

Toward A Science of Sustainable Water Management

NASA Astrophysics Data System (ADS)

Brown, C.

2016-12-01

Societal need for improved water management and concerns for the long-term sustainability of water resources systems are prominent around the world. The continued susceptibility of society to the harmful effects of hydrologic variability, pervasive concerns related to climate change and the emergent awareness of devastating effects of current practice on aquatic ecosystems all illustrate our limited understanding of how water ought to be managed in a dynamic world. The related challenges of resolving the competition for freshwater among competing uses (so called "nexus" issues) and adapting water resources systems to climate change are prominent examples of the of sustainable water management challenges. In addition, largely untested concepts such as "integrated water resources management" have surfaced as Sustainable Development Goals. In this presentation, we argue that for research to improve water management, and for practice to inspire better research, a new focus is required, one that bridges disciplinary barriers between the water resources research focus on infrastructure planning and management, and the role of human actors, and geophysical sciences community focus on physical processes in the absence of dynamical human response. Examples drawn from climate change adaptation for water resource systems and groundwater management policy provide evidence of initial progress towards a science of sustainable water management that links improved physical understanding of the hydrological cycle with the socioeconomic and ecological understanding of water and societal interactions.

Photonics industry in China: from current status and trends to the importance of innovation

NASA Astrophysics Data System (ADS)

Fan, Chongcheng

2011-12-01

Current status and trends in various sectors of photonics industry in Mainland China are reviewed, which includes optical fiber communication, optical preform, fiber and cable, photonic devices and chips, LED illumination and display, and photovoltaics. Then, from the challenges and risks they are facing, critical importance of innovation is discussed. In the evolving Innovation Economy, the core competence of a company, an industry or a country is its innovation power and the capability to grab (and manage) talented people.

Epilepsy and psychosis: a practical approach.

PubMed

Maguire, Melissa; Singh, Jasvinder; Marson, Anthony

2018-04-01

The psychoses of epilepsy can be classified according to their temporal relationship with seizures, namely as ictal, postictal and interictal psychosis. Interictal psychosis is the most common and may resemble schizophrenia. They can be challenging to diagnose and to manage, especially given the perception that some antipsychotic drugs may exacerbate seizures, while some antiepileptic medications may worsen psychosis. The current uncertainty around their best management means that some patients may not receive appropriate care. We propose a practical stepwise approach to managing psychosis in patients with epilepsy, summarising the key clinical features. We provide a framework for diagnosis, investigation and management of psychosis in the acute and long term. We also summarise the available evidence on the risk of psychosis with current antiepileptic drugs and the risk of seizures with antipsychotic drugs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Knowledge management strategies: Enhancing knowledge transfer to clinicians and patients.

PubMed

Roemer, Lorrie K; Rocha, Roberto A; Del Fiol, Guilherme; Bradshaw, Richard L; Hanna, Timothy P; Hulse, Nathan C

2006-01-01

At Intermountain Healthcare (Intermountain), executive clinical content experts are responsible for disseminating consistent evidence-based clinical content throughout the enterprise at the point-of-care. With a paper-based system it was difficult to ensure that current information was received and was being used in practice. With electronic information systems multiple applications were supplying similar, but different, vendor-licensed and locally-developed content. These issues influenced the consistency of clinical practice within the enterprise, jeopardized patient and clinician safety, and exposed the enterprise and its employees to potential financial penalties. In response to these issues Intermountain is developing a knowledge management infrastructure providing tools and services to support clinical content development, deployment, maintenance, and communication. The Intermountain knowledge management philosophy includes strategies guiding clinicians and consumers of health information to relevant best practice information with the intention of changing behaviors. This paper presents three case studies describing different information management problems identified within Intermountain, methods used to solve the problems, implementation challenges, and the current status of each project.

Challenges to effective crisis management: using information and communication technologies to coordinate emergency medical services and emergency department teams.

PubMed

Reddy, Madhu C; Paul, Sharoda A; Abraham, Joanna; McNeese, Michael; DeFlitch, Christopher; Yen, John

2009-04-01

The purpose of this study is to identify the major challenges to coordination between emergency department (ED) teams and emergency medical services (EMS) teams. We conducted a series of focus groups involving both ED and EMS team members using a crisis scenario as the basis of the focus group discussion. We also collected organizational workflow data. We identified three major challenges to coordination between ED and EMS teams including ineffectiveness of current information and communication technologies, lack of common ground, and breakdowns in information flow. The three challenges highlight the importance of designing systems from socio-technical perspective. In particular, these inter-team coordination systems must support socio-technical issues such as awareness, context, and workflow between the two teams.

Biomarkers of tolerance: searching for the hidden phenotype.

PubMed

Perucha, Esperanza; Rebollo-Mesa, Irene; Sagoo, Pervinder; Hernandez-Fuentes, Maria P

2011-08-01

Induction of transplantation tolerance remains the ideal long-term clinical and logistic solution to the current challenges facing the management of renal allograft recipients. In this review, we describe the recent studies and advances made in identifying biomarkers of renal transplant tolerance, from study inceptions, to the lessons learned and their implications for current and future studies with the same goal. With the age of biomarker discovery entering a new dimension of high-throughput technologies, here we also review the current approaches, developments, and pitfalls faced in the subsequent statistical analysis required to identify valid biomarker candidates.

Challenges with Evidence-Based Management of Stable Ischemic Heart Disease.

PubMed

Patel, Amit V; Bangalore, Sripal

2017-02-01

Stable ischemic heart disease (SIHD) is a highly prevalent condition associated with increased costs, morbidity, and mortality. Management goals of SIHD can broadly be thought of in terms of improving prognosis and/or improving symptoms. Treatment options include medical therapy as well as revascularization, either with percutaneous coronary intervention or coronary artery bypass grafting. Herein, we will review the current evidence base for treatment of SIHD as well as its challenges and discuss ongoing studies to help address some of these knowledge gaps. There has been no consistent reduction in death or myocardial infarction (MI) with revascularization vs. medical therapy in patients with SIHD in contemporary trials. Angina and quality of life have been shown to be relieved more rapidly with revascularization vs. optimal medical therapy; however, the durability of these results is uncertain. There have been challenges and limitations in several of the trials addressing the optimal treatment strategy for SIHD due to potential selection bias (due to knowledge of coronary anatomy prior to randomization), patient crossover, and advances in medical therapy and revascularization strategies since trial completion. The challenges inherent to prior trials addressing the optimal management strategy for SIHD have impacted the generalizability of results to real-world cohorts. Until the results of additional ongoing trials are available, the decision for revascularization or medical therapy should be based on patients' symptoms, weighing the risks and benefits of each approach, and patient preference.

A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges.

PubMed

Juengst, Shannon B; Kumar, Raj G; Wagner, Amy K

2017-01-01

Depression is one of the most common conditions to emerge after traumatic brain injury (TBI), and despite its potentially serious consequences it remains undertreated. Treatment for post-traumatic depression (PTD) is complicated due to the multifactorial etiology of PTD, ranging from biological pathways to psychosocial adjustment. Identifying the unique, personalized factors contributing to the development of PTD could improve long-term treatment and management for individuals with TBI. The purpose of this narrative literature review was to summarize the prevalence and impact of PTD among those with moderate to severe TBI and to discuss current challenges in its management. Overall, PTD has an estimated point prevalence of 30%, with 50% of individuals with moderate to severe TBI experiencing an episode of PTD in the first year after injury alone. PTD has significant implications for health, leading to more hospitalizations and greater caregiver burden, for participation, reducing rates of return to work and affecting social relationships, and for quality of life. PTD may develop directly or indirectly as a result of biological changes after injury, most notably post-injury inflammation, or through psychological and psychosocial factors, including pre injury personal characteristics and post-injury adjustment to disability. Current evidence for effective treatments is limited, although the strongest evidence supports antidepressants and cognitive behavioral interventions. More personalized approaches to treatment and further research into unique therapy combinations may improve the management of PTD and improve the health, functioning, and quality of life for individuals with TBI.

The status of the art of human malignant glioma management: the promising role of targeting tumor-initiating cells.

PubMed

Florio, Tullio; Barbieri, Federica

2012-10-01

Glioblastoma is the most prevalent and malignant form of brain cancer, but the current available multimodality treatments yield poor survival improvement. Thus, innovative therapeutic strategies represent the challenging topic for glioblastoma management. Multidisciplinary advances, supporting current standard of care therapies and investigational trials that reveal potential drug targets for glioblastoma are reviewed. A radical change in glioblastoma therapeutic approaches could arise from the identification of cancer stem cells, putative tumor-initiating cells involved in tumor initiation, progression and resistance, as innovative drug target. Still controversial identification of markers and molecular regulators in glioma tumor-initiating cells and novel approaches targeting these cells are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Current Concepts in Orthopedic Management of Multiple Trauma

PubMed Central

Kucukdurmaz, Fatih; Alijanipour, Pouya

2015-01-01

Multiple trauma patients frequently present challenging clinical scenarios with musculoskeletal injuries being the most common indications for surgical procedures in these patients. Despite our substantial knowledge, a universally approved objective definition for “multiple trauma” is yet to be delineated. Several controversial aspects of economics, pathophysiology, animal models, diagnosis, management and outcome of patients with multiple trauma have recently been explored and although some progress has been made, it seems that the available evidence is still inconclusive in some occasions. This manuscript revisits several current concepts of multiple trauma that have been the focus of recent investigation. We aim to provide the reader with an updated perspective based on the most recently published literature in the field of multiple trauma. PMID:26312111

Laparoscopic partial nephrectomy: Technical considerations and an update

PubMed Central

Dominguez-Escrig, Jose L; Vasdev, Nikhil; O’Riordon, Anna; Soomro, Naeem

2011-01-01

The widespread use of radiological imaging (ultrasound, computed tomography and magnetic resonance imaging) has resulted in a steady increase in the incidental diagnosis of small renal masses. While open partial nephrectomy (OPN) remains the reference standard for the management of small renal masses, laparoscopic partial nephrectomy (LPN) continues to evolve. LPN is currently advocated to be at par with OPN oncologically. The steep learning curve and technical demand of LPN make it challenging to establish this as a new procedure. We present a detailed up-to-date review on the previous, current and planned technical considerations for the use of LPN, highlighting important surgical techniques, including single-port and robotic surgery, techniques on improving intra-operative haemostasis and the management of complications specific to LPN. PMID:22022109

Innovating urinary catheter design: An introduction to the engineering challenge.

PubMed

Murphy, Cathy

2018-05-01

Every day, people around the world rely on intermittent and indwelling urinary catheters to manage bladder dysfunction, but the potential or actual harm caused by these devices is well-recognised. Current catheter designs can cause urinary tract infection and septicaemia, bladder and urethral trauma and indwelling devices frequently become blocked. Furthermore, the devices can severely disrupt users' lives, limiting their daily activities and can be costly to manage for healthcare providers. Despite this, little significant design innovation has taken place in the last 80 years. In this article current catheter designs and their limitations are reviewed, common catheter-associated problems are outlined and areas of design ripe for improvement proposed. The potential to relieve the individual and economic burden of catheter use is high.

Conducting Polymers and Their Applications in Diabetes Management.

PubMed

Zhao, Yu; Cao, Luyao; Li, Lanlan; Cheng, Wen; Xu, Liangliang; Ping, Xinyu; Pan, Lijia; Shi, Yi

2016-10-26

Advances in conducting polymers (CPs) have promoted the development of diabetic monitoring and treatment, which is of great significance in human healthcare and modern medicine. CPs are special polymers with physical and electrochemical features resembling metals, inorganic semiconductors and non-conducting polymers. To improve and extend their properties, the fabrication of CPs and CP composites has attracted intensive attention in recent decades. Some CPs are biocompatible and suitable for biomedical use. Thus, the intriguing properties of CPs make wearable, noninvasive, continuous diabetes managing devices and other potential applications in diabetes possible in the near future. To highlight the recent advances of CPs and their derived materials (especially in conducting polymer hydrogels), here we discuss their fabrication and characterization, review the current state-of-the-art research in diabetes management based on these materials and describe current challenges as well as future potential research directions.

The effects of old, new and emerging medicines on metabolic aberrations in PCOS

PubMed Central

Bargiota, Alexandra

2012-01-01

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age that is associated with significant adverse short- and long-term health consequences. Multiple metabolic aberrations, such as insulin resistance (IR) and hyperinsulinaemia, high incidence of impaired glucose tolerance, visceral obesity, inflammation and endothelial dysfunction, hypertension and dyslipidemia are associated with the syndrome. Assessing the metabolic aberrations and their long term health impact in women with PCOS is challenging and becomes more important as therapeutic interventions currently available for the management of PCOS are not fully able to deal with all these consequences. Current therapeutic management of PCOS has incorporated new treatments resulting from the better understanding of the pathophysiology of the syndrome. The aim of this review is to summarize the effect of old, new and emerging therapies used in the management of PCOS, on the metabolic aberrations of PCOS PMID:23148192

Conducting Polymers and Their Applications in Diabetes Management

PubMed Central

Zhao, Yu; Cao, Luyao; Li, Lanlan; Cheng, Wen; Xu, Liangliang; Ping, Xinyu; Pan, Lijia; Shi, Yi

2016-01-01

Advances in conducting polymers (CPs) have promoted the development of diabetic monitoring and treatment, which is of great significance in human healthcare and modern medicine. CPs are special polymers with physical and electrochemical features resembling metals, inorganic semiconductors and non-conducting polymers. To improve and extend their properties, the fabrication of CPs and CP composites has attracted intensive attention in recent decades. Some CPs are biocompatible and suitable for biomedical use. Thus, the intriguing properties of CPs make wearable, noninvasive, continuous diabetes managing devices and other potential applications in diabetes possible in the near future. To highlight the recent advances of CPs and their derived materials (especially in conducting polymer hydrogels), here we discuss their fabrication and characterization, review the current state-of-the-art research in diabetes management based on these materials and describe current challenges as well as future potential research directions. PMID:27792179

The business value and cost-effectiveness of genomic medicine.

PubMed

Crawford, James M; Aspinall, Mara G

2012-05-01

Genomic medicine offers the promise of more effective diagnosis and treatment of human diseases. Genome sequencing early in the course of disease may enable more timely and informed intervention, with reduced healthcare costs and improved long-term outcomes. However, genomic medicine strains current models for demonstrating value, challenging efforts to achieve fair payment for services delivered, both for laboratory diagnostics and for use of molecular information in clinical management. Current models of healthcare reform stipulate that care must be delivered at equal or lower cost, with better patient and population outcomes. To achieve demonstrated value, genomic medicine must overcome many uncertainties: the clinical relevance of genomic variation; potential variation in technical performance and/or computational analysis; management of massive information sets; and must have available clinical interventions that can be informed by genomic analysis, so as to attain more favorable cost management of healthcare delivery and demonstrate improvements in cost-effectiveness.

Teaching of leprosy: current challenges*

PubMed Central

Alves, Cynthia Rossetti Portela; Ribeiro, Maria Mônica Freitas; Melo, Elza Machado; Araújo, Marcelo Grossi

2014-01-01

In the context of declining leprosy endemicity worldwide, keeping the interest in knowledge and expertise in leprosy alive has been a matter of concern. Approaching the problem only in primary care, without the proper integration with other levels of care in the health system fails to account for the complexity of the disease. Training professionals to work at different levels of health care is a current challenge. The objective of this review was to look for experiences related to the teaching of leprosy both in undergraduate courses in the field of health sciences and in training programs for professionals who work in patient care. We highlight the role of the dermatologist in the management of control programs, diagnosis and treatment of the disease, as well as in the continuous education of other health professionals. PMID:24937820

Things to come: postmodern digital knowledge management and medical informatics.

PubMed

Matheson, N W

1995-01-01

The overarching informatics grand challenge facing society is the creation of knowledge management systems that can acquire, conserve, organize, retrieve, display, and distribute what is known today in a manner that informs and educates, facilitates the discovery and creation of new knowledge, and contributes to the health and welfare of the planet. At one time the private, national, and university libraries of the world collectively constituted the memory of society's intellectual history. In the future, these new digital knowledge management systems will constitute human memory in its entirety. The current model of multiple local collections of duplicated resources will give way to specialized sole-source servers. In this new environment all scholarly scientific knowledge should be public domain knowledge: managed by scientists, organized for the advancement of knowledge, and readily available to all. Over the next decade, the challenge for the field of medical informatics and for the libraries that serve as the continuous memory for the biomedical sciences will be to come together to form a new organization that will lead to the development of postmodern digital knowledge management systems for medicine. These systems will form a portion of the evolving world brain of the 21st century.

Can sexual selection theory inform genetic management of captive populations? A review

PubMed Central

Chargé, Rémi; Teplitsky, Céline; Sorci, Gabriele; Low, Matthew

2014-01-01

Captive breeding for conservation purposes presents a serious practical challenge because several conflicting genetic processes (i.e., inbreeding depression, random genetic drift and genetic adaptation to captivity) need to be managed in concert to maximize captive population persistence and reintroduction success probability. Because current genetic management is often only partly successful in achieving these goals, it has been suggested that management insights may be found in sexual selection theory (in particular, female mate choice). We review the theoretical and empirical literature and consider how female mate choice might influence captive breeding in the context of current genetic guidelines for different sexual selection theories (i.e., direct benefits, good genes, compatible genes, sexy sons). We show that while mate choice shows promise as a tool in captive breeding under certain conditions, for most species, there is currently too little theoretical and empirical evidence to provide any clear guidelines that would guarantee positive fitness outcomes and avoid conflicts with other genetic goals. The application of female mate choice to captive breeding is in its infancy and requires a goal-oriented framework based on the needs of captive species management, so researchers can make honest assessments of the costs and benefits of such an approach, using simulations, model species and captive animal data. PMID:25553072

Financial management challenges for general hospital psychiatry 2001.

PubMed

Goldberg, R J

2001-01-01

Psychiatry programs are facing significant business and financial challenges. This paper provides an overview of these management challenges in five areas: departmental, hospital, payment system, general finance, and policy. Psychiatric leaders will require skills in a variety of business management areas to ensure their program success. Many programs will need to develop new compensation models with more of an emphasis on revenue collection and overhead management. Programs which cannot master these areas are likely to go out of business. For academic programs, incentive systems must address not only clinical productivity, but academic and teaching output as well. General hospital programs will need to develop increased sophistication in differential cost accounting in order to be able to advocate for their patients and program in the current management climate. Clinical leaders will need the skills (ranging from actuarial to negotiations) to be at the table with contract development, since those decisions are inseparable from clinical care issues. Strategic planning needs to consider the value of improving integration with primary care, along with the ability to understand the advantages and disadvantages of risk-sharing models. Psychiatry leaders need to define and develop useful reports shared with clinical division leadership to track progress and identify problems and opportunities. Leaders should be responsible for a strategy for developing appropriate information system architecture and infrastructure. Finally, it is hoped that some leaders will emerge who can further our needs to address inequities in mental health fee schedules and parity issues which affect our program viability.

AMCP Partnership Forum: Driving Value and Outcomes in Oncology.

PubMed

2017-05-01

Innovation in cancer treatment has provided a wealth of recently available therapeutic agents and a healthy drug pipeline that promises to change the way we approach this disease and the lives of those affected in the years to come. However, the majority of these new agents, many of which are targeted to specific genomic features of various tumors, may challenge the health care system's ability to afford cancer care. This innovation drives the need to focus on the value of the treatments provided to patients with cancer and on methods to optimize the efficiency of the dollars we spend, in addition to the clinical value itself. The Academy of Managed Care Pharmacy (AMCP) convened a Partnership Forum to address how to improve value and outcomes in cancer care. In this multistakeholder forum, several areas were addressed: current methods for assessing the value of oncology products, the need for balancing population management with precision medicine, and the outlook for value-based contracting for oncology medications in managed care settings. Participants recommended ways in which stakeholders can work toward solutions in these areas. The forum brought together stakeholders from health plans, integrated delivery systems, pharmacy benefit managers, clinical practice, biopharmaceutical industry, and laboratory companies. Also participating were representatives from trade and professional associations. During this 1.5-day forum, participants identified current challenges, readiness, and ways to address value and improve outcomes in cancer therapy. Some of the challenges identified include choosing a viable (and practical) outcome target for value-based contracting in oncology, the development and use of value frameworks and clinical pathways, managing cancer diagnostics, utilization of alternative payment systems, moving from a large evidence base to a small clinical trial base in considering targeted treatments, and lack of best practices in value-based payment arrangements. Addressing these challenges could lead to improving cancer treatment. The AMCP Partnership Forum titled "Driving Value and Outcomes in Oncology" and the development of this report were supported by AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Foundation Medicine, IntrinsiQ Specialty Solutions, Janssen Oncology and Johnson and Johnson Health Systems, Eli Lilly and Company, National Pharmaceutical Council, Novartis Pharmaceuticals Corporation, Pharmaceutical Research and Manufacturers of America, Sanofi, Takeda Oncology, and Xcenda.

Factoring quality laboratory diagnosis into the malaria control agenda for sub-Saharan Africa.

PubMed

Aidoo, Michael

2013-09-01

Recent progress in malaria control in sub-Saharan Africa has been achieved primarily through provision of insecticide-treated nets, indoor residual spraying, and antimalarial drugs. Although these interventions are important, proper case identification and accurate measurement of their impact depend on quality diagnostic testing. Current availability of diagnostic testing for malaria in sub-Saharan Africa is inadequate to support disease management, prevention programs, and surveillance needs. Challenges faced include a dearth of skilled workforce, inadequate health systems infrastructure, and lack of political will. A coordinated approach to providing pre-service clinical and laboratory training together with systems that support a scale-up of laboratory services could provide means not only for effective malaria case management but also, management of non-malaria febrile illnesses, disease surveillance, and accurate control program evaluation. A synthesis of the challenges faced in ensuring quality malaria testing and how to include this information in the malaria control and elimination agenda are presented.

Treatment of hepatocellular carcinoma with portal vein tumor thrombus: advances and challenges.

PubMed

Jiang, Jin-Fang; Lao, Yong-Cong; Yuan, Bao-Hong; Yin, Jun; Liu, Xin; Chen, Long; Zhong, Jian-Hong

2017-05-16

Portal vein tumor thrombus is a frequent, challenging complication in hepatocellular carcinoma. Hepatocellular carcinoma patients with portal vein tumor thrombus may show worse liver function, less treatment tolerance and worse prognosis than patients without portal vein tumor thrombus, and they may be at higher risk of comorbidity related to portal hypertension. Western and some Asian guidelines stratify hepatocellular carcinoma with portal vein tumor thrombus together with metastatic hepatocellular carcinoma and therefore recommend only palliative treatment with sorafenib or other systemic agents. In recent years, more treatment options have become available for hepatocellular carcinoma patients with portal vein tumor thrombus, and an evidence-based approach to optimizing disease management and treatment has become more widespread. Nevertheless, consensus policies for managing hepatocellular carcinoma with portal vein tumor thrombus have not been established. This comprehensive literature review, drawing primarily on studies published after 2010, examines currently available management options for patients with hepatocellular carcinoma and portal vein tumor thrombus.

Medical management of ischemic stuttering priapism: a contemporary review of the literature.

PubMed

Levey, Helen R; Kutlu, Omer; Bivalacqua, Trinity J

2012-01-01

Priapism is defined as a prolonged and persistent erection of the penis without sexual stimulation. This is a poorly understood disease process with little information on the pathophysiology of this erectile disorder. Complications from this disorder are devastating due to the irreversible erectile damage and resultant erectile dysfunction (ED). Stuttering priapism, though relatively rare, affects a high prevalence of men with sickle-cell disease (SCD) and presents a challenging problem with guidelines for treatment lacking or resulting in permanent ED. The mechanisms involved in the development of priapism in this cohort are poorly characterized; therefore, medical management of priapism represents a therapeutic challenge to urologists. Additional research is warranted, so we can effectively target treatments for these patients with prevention as the goal. This review gives an introduction to stuttering priapism and its clinical significance, specifically with regards to the patient with SCD. Additionally, the proposed mechanisms behind its pathophysiology and a summary of the current and future targets for medical management are discussed.

Assessment of temperatures in the vaccine cold chain in two provinces in Lao People's Democratic Republic: a cross-sectional pilot study.

PubMed

Kitamura, Tomomi; Bouakhasith, Viraneth; Phounphenghack, Kongxay; Pathammavong, Chansay; Xeuatvongsa, Anonh; Norizuki, Masataro; Okabayashi, Hironori; Mori, Yoshio; Machida, Munehito; Hachiya, Masahiko

2018-04-27

All childhood vaccines, except the oral polio vaccine, should be kept at 2-8 °C, since the vaccine potency can be damaged by heat or freezing temperature. A temperature monitoring study conducted in 2008-2009 reported challenges in cold chain management from the provincial level downwards. The present cross-sectional pilot study aimed to assess the current status of the cold chain in two provinces (Saravan and Xayabouly) of Lao People's Democratic Republic between March-April 2016. Two types of temperature data loggers recorded the temperatures and the proportions of time exposed to < 0 or > 8 °C were calculated. The temperature remained within the appropriate range in the central and provincial storages. However, the vaccines were frequently exposed to > 8 °C in Saravan and < 0 °C in Xayabouly in the district storage. Vaccines were exposed to > 8 °C during the transportation in Saravan and to both > 8 and < 0 °C in Xayabouly. Thus, challenges in managing the cold chain in the district storage and during transportation remain, despite improvements at the provincial storage. A detailed up-to-date nationwide analysis of the current situation of the cold chain is warranted to identify the most appropriate intervention to tackle the remaining challenges.

The Twin Epidemics of Tuberculosis and HIV.

PubMed

Varghese, George M; Janardhanan, Jeshina; Ralph, Ravikar; Abraham, Ooriapadickal C

2013-02-01

The deadly combination of tuberculosis (TB) and human immunodeficiency virus (HIV) currently ravaging the world, taking a toll of about 0.35 million people every year, is one of the major public health crises of the decade. Throughout the course of HIV infection, the risk of acquisition, reactivation, and reinfection of TB keeps increasing substantially as the immune deficiency progresses. TB coinfected patients inadvertently facilitate HIV infection by release of the proinflammatory cytokines and overexpression of coreceptors CXCR4 and CCR5; thereby, the progression of each is facilitated. The difficulties in diagnosing active tuberculosis in HIV-infected individuals poses a great challenge that is further complicated by the challenges in identification of latent TB infection, creating a setback to preventive therapy. Furthermore, prescribing antituberculous therapy and antiretroviral therapy together poses several management challenges, including drug interactions, added toxicities, and TB immune reconstitution inflammatory syndrome. The current approach to diagnosis, prevention, and treatment strategies in TB and HIV coinfected individuals, along with epidemiology and overview of pathogenetic interplay of both microbes, is reviewed here.

Challenging fat talk: An experimental investigation of reactions to body disparaging conversations.

PubMed

Ambwani, Suman; Baumgardner, Megan; Guo, Cai; Simms, Lea; Abromowitz, Emily

2017-12-01

Although "fat talk" is associated with increased eating disorder risk, the predictors of fat talk engagement and viable alternatives to these pervasive conversations remain unclear. The current experiment examined responses to fat talk versus feminist-oriented challenging fat talk scenarios. Undergraduate women (N=283) completed baseline questionnaires assessing body dissatisfaction, fat talk engagement, and positive impression management. One week later, they were randomized to view one of the two scenarios, followed by assessment of mood, fat talk engagement, social acceptability, and social likeability. Results indicated that the challenging fat talk vignette (versus the fat talk vignette) yielded less negative affect and fat talk and was perceived as more socially attractive with a more likeable target character. Baseline body dissatisfaction, baseline fat talk tendencies, and momentary negative affect predicted post-exposure fat talk engagement. Current findings highlight possibilities for implementing feminist language and psychoeducation in fat talk prevention efforts. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Long-term care in Europe. Challenges and strategies in nursing staff management].

PubMed

Kuhlmann, E; Larsen, C

2013-08-01

Across Europe, long-term care (LTC) is one of the most challenging areas of social policy. Despite a growing awareness of the problems and improved data, current institutional reforms are an ineffective response to demographic change. This article aims to provide an overview of the challenges of future nursing and care staff in LTC in Europe, and to discuss the German case in a wider European context. We focus on the nursing workforce and on the link between current and prospective analyses on the demand and offer of LTC services and LTC professionals/nursing staff. We draw on a secondary analysis of the literature and public statistics, especially OECD data. The European comparison shows a high variation in the future demand for LTC. In Germany, a number of problematic trends create a negative scenario: the growing demand for LTC meets with a decrease in nursing staff on the supply side. We conclude by suggesting intervention strategies that may reduce this negative scenario.

A complex case of congenital cystic renal disease

PubMed Central

Cordiner, David S; Evans, Clair A; Brundler, Marie-Anne; McPhillips, Maeve; Murio, Enric; Darling, Mark; Taheri, Sepideh

2012-01-01

This case outlines the potential complexity of autosomal recessive polycystic kidney disease (ARPKD). It highlights the challenges involved in managing this condition, some of the complications faced and areas of uncertainty in the decision making process. With a paucity of published paediatric cases on this subject, this should add to the pool of information currently available. PMID:22605879

Innovative manure treatments in the USA – state of the art (Tratamientos Innovadores de estiercoles en USA - estado del arte)

USDA-ARS?s Scientific Manuscript database

Currently, the potential impact of manure on the environment represents one of the world agriculture’s major challenges. Treatment technologies can play an important role in the management of livestock manure by providing a more flexible approach to land application and acreage limitations and by so...

Recent emissions research in southwestern shrub and grassland fuels

Treesearch

David R. Weise; Wayne Miller; David R. Cocker; Heejung Jung; Seyedehsan Hosseini; Marko Princevac; Robert J. Yokelson; Ian Burling; Sheryl Akagi; Shawn Urbanski; WeiMin Hao

2015-01-01

While it is currently challenging to use prescribed burning in chaparral and other southwestern shrub fuel types due to many constraints, any such activities require smoke management planning. Information on fuels and emissions from chaparral were limited and based on older sampling systems. The DoD SERDP program funded a project to measure fuels and smoke emissions in...

Assessing the Universal Basic Education Primary and Koranic Schools' Synergy for "Almajiri" Street Boys in Nigeria

ERIC Educational Resources Information Center

Usman, Lantana M.

2008-01-01

Purpose: The purpose of this paper is to show how Nigeria's current Universal Basic Education on primary schooling targets Muslim "Almajiri" street boys for basic literacy acquisition. The paper examines the policy's management implementation practices and challenges, as well as provides policy options that may minimize discrepancies for…

The impacts of increasing drought on forest dynamics, structure, and biodiversity in the United States

Treesearch

James S. Clark; Louis Iverson; Christopher W. Woodall; Craig D. Allen; David M. Bell; Don C. Bragg; Anthony W. D' Amato; Frank W. Davis; Michelle H. Hersh; Ines Ibanez; Stephen T. Jackson; Stephen Matthews; Neil Pederson; Matthew Peters; Mark W. Schwartz; Kristen M. Waring; Niklaus E. Zimmermann

2016-01-01

We synthesize insights from current understanding of drought impacts at stand-to-biogeographic scales, including management options, and we identify challenges to be addressed with new research. Large stand-level shifts underway in western forests already are showing the importance of interactions involving drought, insects, and fire. Diebacks, changes in composition...

Large-Scale Innovation and Change in UK Higher Education

ERIC Educational Resources Information Center

Brown, Stephen

2013-01-01

This paper reflects on challenges universities face as they respond to change. It reviews current theories and models of change management, discusses why universities are particularly difficult environments in which to achieve large scale, lasting change and reports on a recent attempt by the UK JISC to enable a range of UK universities to employ…

Making It Real: Incorporating Cost Management and Productivity Improvements into Financing Decisions

ERIC Educational Resources Information Center

Wellman, Jane

2010-01-01

Higher education is being challenged to increase access and degree attainment for all student groups--a tall order under any circumstances, but particularly daunting in the current economy. To do this, institutional and policy leaders will need to find ways to reduce costs and permanently reduce spending demands while they maintain access. This…

The Balancing Act: How Principals Perceive the Competing Demands of Instructional Leadership and Managerial Leadership

ERIC Educational Resources Information Center

Sharpe, Robert R.

2012-01-01

It is becoming increasingly difficult for principals to manage the challenges found in the current educational environment. Principals must lead schools as they juggle the many demands of the contemporary principalship. Principals often struggle in balancing the expectations of their many roles and responsibilities. At the center of this problem…

The Phenomenon of "Being-In-Management" in Executive Education Programmes: An Integrative View

ERIC Educational Resources Information Center

Sewchurran, Kosheek; McDonogh, Jennifer

2015-01-01

Currently, we experience a situation in society in general as well as business school education where leaders and executives prefer to remain ambivalent and inauthentic about humanity's worsening socio-economic challenges. As a result of this, we continue with regimes of common sense that have lost their legitimacy and perpetuate an unsustainable…

An Ensemble Approach in Converging Contents of LMS and KMS

ERIC Educational Resources Information Center

Sabitha, A. Sai; Mehrotra, Deepti; Bansal, Abhay

2017-01-01

Currently the challenges in e-Learning are converging the learning content from various sources and managing them within e-learning practices. Data mining learning algorithms can be used and the contents can be converged based on the Metadata of the objects. Ensemble methods use multiple learning algorithms and it can be used to converge the…

The Battle over Professorship: Reform of Human Resource Management and Academic Careers in a Comparative Perspective

ERIC Educational Resources Information Center

Majcher, Agnieszka

2008-01-01

Changing conditions of academic and scientific labour markets challenge the current conceptual thinking about the mechanisms of academic promotion, selection and recruitment. This paper explores the models of academic promotion and recruitment of professors in a comparative perspective using the examples of Poland and Germany, and addresses the…

Proceedings of the sixth California oak symposium: today's challenges, tomorrow's opportunities

Treesearch

Adina Merenlender; Douglas McCreary; Kathryn L. Purcell

2008-01-01

The Sixth Oak Symposium provided a forum for current research and outstanding case studies on oak woodland science and sustainability in California. This symposium was the latest in a series of conferences on this subject held every 5 years since 1979. The proceedings from this conference series represent the most comprehensive source of scientific and management...

Teachers' Sensemaking about Implementation of an Innovative Science Curriculum across the Settings of Professional Development and Classroom Enactment

ERIC Educational Resources Information Center

de los Santos, Xeng

2017-01-01

Designing professional development that effectively supports teachers in learning new and often challenging practices remains a dilemma for teacher educators. Within the context of current reform efforts in science education, such as the "Next Generation Science Standards," teacher educators are faced with managing the dilemma of how to…

Raising Students' Awareness of the Implications of Multimodality for Content Design and Usability: The Web Site Project

ERIC Educational Resources Information Center

Planken, Brigitte; Kreps, Arnold J.

2006-01-01

As advances in information communication technology have continued to affect business communication, the challenge for teachers over the past decade has been to stay abreast of new developments by integrating into the curriculum current theoretical and practice-based perspectives that can inform their students how to effectively create, manage,…

Identifying Governance Best Practices in Systems-of-Systems Acquisition

DTIC Science & Technology

2014-02-08

Acquisition Governance ................................................ 28  Figure 3.  Harvest Hercules Airborne Weapons Kit System Components ...... 39 ...acquisition poses considerable challenges that the current Department of Defense (DoD) acquisition governance structure was not necessarily designed to...specify the warship it needed along with the design , construction, and outfitting of the ship. The Navy managed and performed production operations and

Demand-side management: Why ratemaking should`nt control tax policy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Haney, J.D.

1995-01-01

As utilities spend money on demand-side management (DSM) programs, they usually deduct their costs currently as ordinary and necessary business expenses. However, state regulators may force deferral of DSM costs for ratemaking purposes, with possible consequences on tax returns. When regulators defer DSM costs, the Internal Revenue Service (IRS) has offered several theories to challenge current tax deductions. One theory requires capitilization instead of a current deduction if regulators include the DSM cost in rate base and provide for a rate of return on the balance. The IRS explained this theory two years ago in a White Paper on conservationmore » expenses: The direct relationship between a rate of return allowed by the Regulator for conservation expenditures allowed in rate base and future profits establishes a prima facie case for capitalization under the future benefit standard. The authors believe that IRS policy should not be linked to ratemaking decisions.« less

Age-related macular degeneration: current treatments

PubMed Central

Hubschman, Jean Pierre; Reddy, Shantan; Schwartz, Steven D

2009-01-01

Purpose: Although important progress has been made in understanding age-related macular degeneration (AMD), management of the disease continues to be a challenge. AMD research has led to a widening of available treatment options and improved prognostic perspectives. This essay reviews these treatment options. Design: Interpretative essay. Methods: Literature review and interpretation. Results: Current treatments to preserve vision in patients with non-exudative AMD include antioxidant vitamins and mineral supplementations. Exudative AMD is currently most often treated monthly with anti-VEGF intravitreal injections. However, investigators are beginning to experiment with combination therapy and surgical approaches in an attempt to limit the number of treatment and reduce the financial burden on the health care system. Conclusion: By better understanding the basis and pathogenesis of AMD, newer therapies will continue to be developed that target specific pathways in patients with AMD, with the hoped for outcome of better management of the disease and improved visual acuity. PMID:19668560

Clinical proteomics-driven precision medicine for targeted cancer therapy: current overview and future perspectives.

PubMed

Zhou, Li; Wang, Kui; Li, Qifu; Nice, Edouard C; Zhang, Haiyuan; Huang, Canhua

2016-01-01

Cancer is a common disease that is a leading cause of death worldwide. Currently, early detection and novel therapeutic strategies are urgently needed for more effective management of cancer. Importantly, protein profiling using clinical proteomic strategies, with spectacular sensitivity and precision, offer excellent promise for the identification of potential biomarkers that would direct the development of targeted therapeutic anticancer drugs for precision medicine. In particular, clinical sample sources, including tumor tissues and body fluids (blood, feces, urine and saliva), have been widely investigated using modern high-throughput mass spectrometry-based proteomic approaches combined with bioinformatic analysis, to pursue the possibilities of precision medicine for targeted cancer therapy. Discussed in this review are the current advantages and limitations of clinical proteomics, the available strategies of clinical proteomics for the management of precision medicine, as well as the challenges and future perspectives of clinical proteomics-driven precision medicine for targeted cancer therapy.

Historical aspects of Pott's disease (spinal tuberculosis) management.

PubMed

Tuli, Surendar M

2013-06-01

Spinal tuberculosis has existed in human beings since the ascent of man on earth. Historically, the management has progressed from regional orthodox therapies to the current, more effective, drugs. Historical perspectives regarding the management have been collated by going through the important publications during the past 6 decades. For convenience, the manuscript has been organized as "orthodox traditional" treatment, early "chemotherapy period", "post chemotherapy treatment", "middle-path" philosophy, and the current treatment with availability of modern imaging facilities. Broad conclusions based upon the published data and personal observations (1959-2011) are summarized as follows: If diagnosis is made at predestructive stage and the patient is treated by standard drugs, the infection would heal in about 95 % patients without significant deformities and complications. Neural complications are still encountered in general hospital outpatients. Diagnosis and treatment at early stages would resolve the neurology without operation in about 40 % of cases. Nearly 60 % of patients would require to be operatively decompressed without jeopardizing mechanical stability. However, despite current treatment approximately 8 % of tuberculous paraplegics do not recover functionally. Immunocompromised state and multidrug resistance to standard drugs (8 to 10 %) are the current (and future) challenges to the doctors and the society.

Technologies and decision support systems to aid solid-waste management: a systematic review.

PubMed

Vitorino de Souza Melaré, Angelina; Montenegro González, Sahudy; Faceli, Katti; Casadei, Vitor

2017-01-01

Population growth associated with population migration to urban areas and industrial development have led to a consumption relation that results in environmental, social, and economic problems. With respect to the environment, a critical concern is the lack of control and the inadequate management of the solid waste generated in urban centers. Among the challenges are proper waste-collection management, treatment, and disposal, with an emphasis on sustainable management. This paper presents a systematic review on scientific publications concerning decision support systems applied to Solid Waste Management (SWM) using ICTs and OR in the period of 2010-2013. A statistical analysis of the eighty-seven most relevant publications is presented, encompassing the ICTs and OR methods adopted in SWM, the processes of solid-waste management where they were adopted, and which countries are investigating solutions for the management of solid waste. A detailed discussion on how the ICTs and OR methods have been combined in the solutions was also presented. The analysis and discussion provided aims to help researchers and managers to gather insights on technologies/methods suitable the SWM challenges they have at hand, and on gaps that can be explored regarding technologies/methods that could be useful as well as the processes in SWM that currently do not benefit from using ICTs and OR methods. Copyright © 2016 Elsevier Ltd. All rights reserved.

Sharing lessons learned and best practices in deactivation and decommissioning techniques among U.S. Department of Energy contractors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lackey, Michael B.; Waisley, Sandra L.; Dusek, Lansing G.

2007-07-01

Approximately $153.2 billion of work currently remains in the United States Department of Energy's (DOE's) Office of Environmental Management (EM) life cycle budget for United States projects. Contractors who manage facilities for the DOE have been challenged to identify transformational changes to reduce the life cycle costs and develop a knowledge management system that identifies, disseminates, and tracks the implementation of lessons learned and best practices. At the request of the DOE's EM Office of Engineering and Technology, the Energy Facility Contractors Group (EFCOG) responded to the challenge with formation of the Deactivation and Decommissioning (D and D) and Facilitymore » Engineering (DD/FE) Working Group. Since October 2006, members have already made significant progress in realizing their goals: adding new D and D best practices to the existing EFCOG Best Practices database; participating in lessons learned forums; and contributing to a DOE initiative on identifying technology needs. The group is also participating in a DOE project management initiative to develop implementation guidelines, as well as a DOE radiation protection initiative to institute a more predictable and standardized approach to approving authorized limits and independently verifying cleanup completion at EM sites. Finally, a D and D hotline to provide real-time solutions to D and D challenges is also being launched. (authors)« less

Implementation of Policies and Strategies for Control of Noncommunicable Diseases in Malawi: Challenges and Opportunities.

PubMed

Lupafya, Phindile Chitsulo; Mwagomba, Beatrice L Matanje; Hosig, Kathy; Maseko, Lucy M; Chimbali, Henry

2016-04-01

Malawi is a Sub-Saharan African country experiencing the epidemiological transition from predominantly infectious to noncommunicable diseases (NCDs) with dramatically increasing prevalence of lifestyle-related diseases such as obesity, hypertension, and diabetes. Malawi's 2011-2016 Health Sector Strategic Plan included NCDs, and an NCD Control Program was established with subsequent development of a National Action Plan for prevention and management of NCDs launched in 2013. The current study was designed to identify gaps in implementation of NCD control program policies and action plan strategies by describing current efforts toward prevention and management of NCDs in Malawi with emphasis on challenges and opportunities. Semistructured questionnaires were used to collect quantitative and qualitative data from Malawi Ministry of Health personnel (senior officers, service providers, health education officers, and nutritionists) in 10 health districts and 3 central hospitals. Frequencies were generated for quantitative data. Qualitative data were used to generate themes and most common responses. Results showed that current services focus on facility-based NCD screening and clinical services rather than active screening, prevention, and community awareness and outreach, although respondents emphasized the importance of prevention, lifestyle education, and community outreach. Respondents indicated inadequate resources for NCD services including financial capital, human resources, equipment and supplies, and transportation. While Malawi has begun to address NCDs, policy and practice implications include (a) better integration of services within the existing infrastructure with emphasis on capacity building; (b) greater implementation of planned NCD activities; (c) a stronger, more comprehensive data management system; and (d) innovative funding solutions. © 2015 Society for Public Health Education.

Integrated care: theory to practice.

PubMed

Stokes, Jonathan; Checkland, Kath; Kristensen, Søren Rud

2016-10-01

'Integrated care' is pitched as the solution to current health system challenges. In the literature, what integrated care actually involves is complex and contested. Multi-disciplinary team case management is frequently the primary focus of integrated care when implemented internationally. We examine the practical application of integrated care in the NHS in England to exemplify the prevalence of the case management focus. We look at the evidence for effectiveness of multi-disciplinary team case management, for the focus on high-risk groups and for integrated care more generally. We suggest realistic expectations of what integration of care alone can achieve and additional research questions. © The Author(s) 2016.

Managing patients with chronic cough: challenges and solutions.

PubMed

Perotin, Jeanne-Marie; Launois, Claire; Dewolf, Maxime; Dumazet, Antoine; Dury, Sandra; Lebargy, François; Dormoy, Valérian; Deslee, Gaëtan

2018-01-01

Chronic cough is a common complaint and a frequent cause of medical consultation. Its management can be difficult. We present here an overview of the current guidelines for the management of chronic cough. Different steps are detailed, including the initial research of an obvious etiology and alert signs that should lead to further investigation of underlying condition. The diagnosis of the most frequent causes: asthma, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease and upper airway cough syndrome should be considered, assessed and treated accordingly. Recent advances have been made in the comprehension of refractory chronic cough pathophysiology as well as its pharmacologic and non-pharmacologic treatment, especially speech pathology therapy.

Challenges in obesity research.

PubMed

Palou, Andreu; Bonet, M Luisa

2013-09-01

Obesity is the main nutritional problem and one of the most important health problems in developed societies. Central to the challenge of obesity prevention and management is a thoroughly understanding of its determinants. Multiple socio-cultural, socio-economic, behavioural and biological factors--often interrelated and many of them still unknown or poorly understood--can contribute to the establishment and perpetuation of obese phenotypes. Here, we address current research challenges regarding basic aspects of obesity and emerging science for its control, including brown adipose tissue thermogenesis and browning of white fat as possible therapeutic targets for obesity, the influence of the microbioma, and genetics, epigenetics, nutrigenomics and nutrigenetics of obesity. We also highlight hot topics in relation to food and lifestyle as determinants of obesity, including the brain mechanisms underlying environmental motivation to eat, the biological control of spontaneous physical activity, the possible role of concrete foods and food components, and the importance of early life nutrition and environment. Challenges regarding the connections of obesity with other alterations and pathologies are also briefly addressed, as well as social and economical challenges in relation to healthy food production and lifestyle for the prevention of obesity, and technological challenges in obesity research and management. The objective is to give a panoramic of advances accomplished and still ahead relevant to the different stakeholders engaged in understanding and combating obesity. Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.

Increasing the relevance of research to health care managers: hospital CEO imperatives for improving quality and lowering costs.

PubMed

Alexander, Jeffrey A; Hearld, Larry R; Jiang, H Joanna; Fraser, Irene

2007-01-01

Evidence-based management assumes that available research evidence is consistent with the problems and decision-making conditions faced by those who will utilize this evidence in practice. This article attempts to identify how hospital leaders view key determinants of hospital quality and costs, as well as the fundamental ways these leaders "think" about solutions to quality and cost issues in their organizations. The objective of this analysis is to better inform the research agenda and approaches pursued by health services research so that this research reflects the "realities" of practice in hospitals. We conducted a series of semistructured interviews with a convenience sample of eight hospital and three health system leaders. Questions focused on current and future challenges facing hospitals as they relate to hospital quality, costs, and efficiency, and potential solutions to those challenges. Nine major organizational and managerial factors emerged from the interviews, including staffing, evidence-based practice, information technology, data availability and benchmarking, and leadership. Hospital leaders tend to think about these factors systemically and consider process-related factors as the important drivers of cost and quality. The results suggest a need to expand the methods utilized by health services researchers to make their research more relevant to health care managers. Expanding research methods to reflect the systemic way that managers view the challenges and solutions facing their organizations may enhance the application of research findings into management practice. Finally, better communication is needed between the research and practice communities. Researchers must learn to think more like managers if their research is to be relevant, and managers must learn to more effectively communicate their issues with the research community and frame their problems in researchable terms.

Challenges, coping strategies, and recommendations related to the HIV services field in the HAART era: a systematic literature review of qualitative studies from the United States and Canada.

PubMed

Kerr, Zachary Y; Miller, Katye R; Galos, Dylan; Love, Randi; Poole, Charles

2013-02-01

Qualitative research methods have been utilized to study the nature of work in the HIV services field. Yet current literature lacks a Highly Active Anti-Retroviral Treatment (HAART) era compendium of qualitative research studying challenges and coping strategies in the field. This study systematically reviewed challenges and coping strategies that qualitative researchers observed in the HIV services field during the HAART era, and their recommendations to organizations. Four online databases were searched for peer-reviewed research that utilized qualitative methods, were published from January 1998 to February 2012, utilized samples of individuals in the HIV services field; occurred in the U.S. or Canada, and contained information related to challenges and/or coping strategies. Abstracts were identified (n=846) and independently read and coded for inclusion by at least two of the four first authors. Identified articles (n=26) were independently read by at least two of the four first authors who recorded the study methodology, participant demographics, challenges and coping strategies, and recommendations. A number of challenges affecting those in the HIV services field were noted, particularly interpersonal and organizational issues. Coping strategies were problem- and emotion-focused. Summarized research recommendations called for increased support, capacity-building, and structural changes. Future research on challenges and coping strategies must provide up-to-date information to the HIV services field while creating, implementing, and evaluating interventions to manage current challenges and reduce the risk of burnout.

Unexpectedly large impact of forest management and grazing on global vegetation biomass

PubMed Central

Erb, K.-H.; Bais, A.L.S.; Carvalhais, N.; Fetzel, T.; Gingrich, S.; Haberl, H.; Lauk, C.; Niedertscheider, M.; Pongratz, J.; Thurner, M.; Luyssaert, S.

2017-01-01

Carbon stocks in vegetation play a key role in the climate system1–4, but their magnitude and patterns, their uncertainties, and the impact of land use on them remain poorly quantified. Based on a consistent integration of state-of-the art datasets, we show that vegetation currently stores ~450 PgC. In the hypothetical absence of land use, potential vegetation would store ~916 PgC, under current climate. This difference singles out the massive effect land use has on biomass stocks. Deforestation and other land-cover changes are responsible for 53-58% of the difference between current and potential biomass stocks. Land management effects, i.e. land-use induced biomass stock changes within the same land cover, contribute 42-47% but are underappreciated in the current literature. Avoiding deforestation hence is necessary but not sufficient for climate-change mitigation. Our results imply that trade-offs exist between conserving carbon stocks on managed land and raising the contribution of biomass to raw material and energy supply for climate change mitigation. Efforts to raise biomass stocks are currently only verifiable in temperate forests, where potentials are limited. In contrast, large uncertainties hamper verification in the tropical forest where the largest potentials are located, pointing to challenges for the upcoming stocktaking exercises under the Paris agreement. PMID:29258288

Translating reference doses into allergen management practice: challenges for stakeholders.

PubMed

Crevel, René W R; Baumert, Joseph L; Luccioli, Stefano; Baka, Athanasia; Hattersley, Sue; Hourihane, Jonathan O'B; Ronsmans, Stefan; Timmermans, Frans; Ward, Rachel; Chung, Yong-joo

2014-05-01

Risk assessment describes the impact of a particular hazard as a function of dose and exposure. It forms the foundation of risk management and contributes to the overall decision-making process, but is not its endpoint. This paper outlines a risk analysis framework to underpin decision-making in the area of allergen cross-contact. Specifically, it identifies challenges relevant to each component of the risk analysis: risk assessment (data gaps and output interpretation); risk management (clear and realistic objectives); and risk communication (clear articulation of risk and benefit). Translation of the outputs from risk assessment models into risk management measures must be informed by a clear understanding of the model outputs and their limitations. This will lead to feasible and achievable risk management objectives, grounded in a level of risk accepted by the different stakeholders, thereby avoiding potential unintended detrimental consequences. Clear, consistent and trustworthy communications actively involving all stakeholders underpin these objectives. The conclusions, integrating the perspectives of different stakeholders, offer a vision where clear, science-based benchmarks form the basis of allergen management and labelling, cutting through the current confusion and uncertainty. Finally, the paper recognises that the proposed framework must be adaptable to new and emerging evidence. Copyright © 2014 ILSI Europe. Published by Elsevier Ltd.. All rights reserved.

One Northwest community - People, salmon, rivers, and the sea: Towards sustainable salmon fisheries

USGS Publications Warehouse

MacDonald, Donald D.; Steward, Cleveland R.; Knudsen, E. Eric; Knudsen, E. Eric; Steward, Cleveland R.; MacDonald, Donald; Williams, Jack E.; Reiser, Dudley W.

1999-01-01

Pacific salmon management is in crisis. Throughout their range, salmon and steelhead populations are being adversely affected by human activities. Without coordinated, effective, and timely action, the future of the Pacific salmon resource is most certainly in doubt. To address the challenges that are currently facing salmon management, concerned citizens representing a diverse array of government agencies and non-governmental organizations have agreed to cooperate in the development of a Sustainable Fisheries Strategy for west coast salmon and steelhead populations. The Strategy builds on the contents of this book, resulting from the Sustainable Fisheries Conference and subsequent community- and watershed-based citizen forums. This chapter presents the key elements of the Strategy including a common vision for the future, a series of guiding principles, and specific strategies for supporting sustainable fisheries. As such, the Strategy embraces an ecosystem-based approach to managing human activities, rather than the traditional egocentric approach to managing salmonid populations and associated habitats. A system of community-based, watershed-oriented councils, including all stakeholders and agency representatives, is proposed for effective transition to ecosystem-based salmon and steelhead management. It is our hope that everyone involved in Pacific salmon management will embrace both the spirit and the specific elements of the Sustainable Fisheries Strategy as we face the difficult challenges ahead.

Demystifying pediculosis: school nurses taking the lead.

PubMed

Pontius, Deborah J

2014-01-01

The treatment of Pediculosis capitis, or head lice, is fraught with misinformation, myths, and mismanagement. Common myths include the need to exclude children from school, the need to remove all visible nits ("no-nit" policies), the need for massive environmental cleaning, that head lice live for long periods of time, and that schools are a common location for lice transmission. Head lice are a common childhood nuisance, causing embarrassment and emotional trauma in both children and families. This article explores and challenges the commonly held beliefs about the identification, management, and treatment of Pediculosis by presenting current recommended evidence-based practice. It also challenges pediatric nurses, and school nurses in particular, in alignment with the National Association of School Nurses (NASN) Position Statement on Pediculosis Management in the School Setting, to act as change agents for reasonable and effective school policies and practices.

The challenge of establishing treatment efficacy for cutaneous vascular manifestations of systemic sclerosis.

PubMed

Pauling, John D

2018-05-01

The cutaneous vascular manifestations of systemic sclerosis (SSc) comprise Raynaud's phenomenon, cutaneous ulceration, telangiectasia formation and critical digital ischaemia; each of which are associated with significant disease-related morbidity. Despite the availability of multiple classes of vasodilator therapy, many of which have been the subject of RCTs, a limited number of pharmacological interventions are currently approved for the management of cutaneous vascular manifestations of SSc. Areas covered: A major challenge has been demonstrating treatment efficacy with examples of promising therapies yielding contrasting results in controlled trial settings. Differences between consensus best-practice guidelines, evidence-based recommendations and marketing approvals in different jurisdictions has resulted in geographic variation in clinical practice concerning the management of cutaneous vascular manifestations of SSc. Difficulty demonstrating treatment efficacy risks waning industry engagement for drug development programmes in this field. This article highlights the key challenges in establishing treatment efficacy and barriers that must be overcome to support successful clinical trial programmes across the spectrum of cutaneous vascular manifestations of SSc. Expert commentary: The paucity of approved treatments for cutaneous vascular manifestations of SSc relates as much to challenges in clinical trial design and the need for reliable clinical trial endpoints, as to lack of therapeutic options.

Review article: Paediatric status epilepticus in the pre-hospital setting: An update.

PubMed

Furyk, Jeremy; Watt, Kerriane; Emeto, Theophilus I; Dalziel, Stuart; Bodnar, Daniel; Riney, Kate; Babl, Franz E

2017-08-01

Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand. The review outlines current definitions and guidelines of SE management, regional variability in pre-hospital protocols within Australasia and aspects of pre-hospital care that could potentially be improved. Contemporary data is required to determine current practice in our setting. It is important that paediatric neurologists, emergency physicians and pre-hospital care providers are all engaged in future endeavours to improve clinical care and knowledge translation efforts for this patient group. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Brine production strategy modeling for active and integrated management of water resources in CCS

NASA Astrophysics Data System (ADS)

Court, B.; Celia, M. A.; Nordbotten, J. M.; Buscheck, T. A.; Elliot, T. J.; Bandilla, K.; Dobossy, M.

2010-12-01

Our society is at present highly dependent on coal, which will continue to play a major role in baseload electricity production in the coming decades. Most projected climate change mitigation strategies require CO2 Capture and Sequestration (CCS) as a vital element to stabilize CO2 atmospheric emissions. In these strategies, CCS will have to expand in the next two decades by several orders of magnitude compared to current worldwide implementation. At present the interactions among freshwater extraction, CO2 injection, and brine management are being considered too narrowly across CCS operations, and in the case of freshwater almost completely overlooked. Following the authors’ recently published overview of these challenges, an active and integrated management of water resources throughout CCS operations was proposed to avoid overlooking critical challenges that may become major obstacles to CCS implementation. Water resources management is vital for several reasons including that a coal-fired power plant retrofitted for CCS requires twice as much cooling water as the original plant. However this increased demand may be accommodated by brine extraction and treatment, which would concurrently function as large-scale pressure management and a potential source of freshwater. Synergistic advantages of such proactive integration that were identified led the authors to concluded that: Active management of CCS operations through an integrated approach -including brine production, treatment, use for cooling, and partial reinjection- can address challenges simultaneously with several synergistic advantages; and, that freshwater and brine must be linked to CO2 and pressure as key decision making parameters throughout CCS operations while recognizing scalability and potential pore space competition challenges. This work presents a detailed modeling investigation of a potential integration opportunity resulting from brine production. Technical results will focus solely on the conjunctive use of saline aquifers for CO2 sequestration and water supply for power plants. The impact of CO2 injection-brine withdrawal coupling on (i) the CO2 injection plume, (ii) the pressure field, and (iii) CO2 and brine leakage risk will be quantified using a range of simulation codes from Schlumberger’s full numerical ECLIPSE model to a simplified analytical model, in an effort to complement useful work initiated at Lawrence Livermore National Laboratory. In particular the impact of different relative permeability and capillary pressure curves on these three components will be presented and put in context of current modeling risk analysis approach in the CCS scientific community.

Advances in the understanding and clinical management of mastocytosis and clonal mast cell activation syndromes

PubMed Central

2016-01-01

Clonal mast cell activation syndromes and indolent systemic mastocytosis without skin involvement are two emerging entities that sometimes might be clinically difficult to distinguish, and they involve a great challenge for the physician from both a diagnostic and a therapeutic point of view. Furthermore, final diagnosis of both entities requires a bone marrow study; it is recommended that this be done in reference centers. In this article, we address the current consensus and guidelines for the suspicion, diagnosis, classification, treatment, and management of these two entities. PMID:27909577

Advances in the understanding and clinical management of mastocytosis and clonal mast cell activation syndromes.

PubMed

González-de-Olano, David; Matito, Almudena; Orfao, Alberto; Escribano, Luis

2016-01-01

Clonal mast cell activation syndromes and indolent systemic mastocytosis without skin involvement are two emerging entities that sometimes might be clinically difficult to distinguish, and they involve a great challenge for the physician from both a diagnostic and a therapeutic point of view. Furthermore, final diagnosis of both entities requires a bone marrow study; it is recommended that this be done in reference centers. In this article, we address the current consensus and guidelines for the suspicion, diagnosis, classification, treatment, and management of these two entities.

Diagnosis and management of premalignant penile lesions

PubMed Central

Shabbir, Majid; Minhas, Suks; Muneer, Asif

2011-01-01

Diagnosing premalignant penile lesions from benign penile dermatoses presents a unique challenge. The rarity of these conditions and the low incidence of penile cancer mean that the majority of our knowledge is based on small, non-randomized, retrospective studies. The introduction of specialist penile cancer centres in the UK has resulted in the centralization of expertise and resources, and has furthered our understanding of the biological behaviour and management of this rare malignancy. We review the current trends in the approach to diagnosing and treating various premalignant penile conditions. PMID:21904571

Defined contribution defined: health insurance for the next century.

PubMed

Marhula, D C; Shannon, E G

2001-01-01

The consumerism movement will dramatically affect the current payer model and present a new series of challenges for managed care organizations. Employers will fuel the changes, as they create health benefit programs that are modeled after retirement programs. In these cases, employers will shift a major portion of financial responsibility to employees, who will be asked to make buying decisions often previously determined by managed care organizations. New business entities known as health navigators will be formed to aid consumers. However, many structural and policy obstacles may slow or transform the consumerism movement.

Do employee health management programs work?

PubMed

Serxner, Seth; Gold, Daniel; Meraz, Angela; Gray, Ann

2009-01-01

Current peer review literature clearly documents the economic return and Return-on-Investment (ROI) for employee health management (EHM) programs. These EHM programs are defined as: health promotion, self-care, disease management, and case management programs. The evaluation literature for the sub-set of health promotion and disease management programs is examined in this article for specific evidence of the level of economic return in medical benefit cost reduction or avoidance. The article identifies the methodological challenges associated with determination of economic return for EHM programs and summarizes the findings from 23 articles that included 120 peer review study results. The article identifies the average ROI and percent health plan cost impact to be expected for both types of EHM programs, the expected time period for its occurrence, and caveats related to its measurement.

Current and future prospects in the management of granulomatosis with polyangiitis (Wegener’s granulomatosis)

PubMed Central

Tarzi, Ruth M; Pusey, Charles D

2014-01-01

Granulomatosis with polyangiitis (GPA, formerly Wegener’s granulomatosis) is a multisystem autoimmune condition associated with anti-neutrophil cytoplasm antibodies. Management of GPA can be complex, owing to the sometimes fulminant and multisystem nature of the presentation, the age demographics of the affected population, and a significant incidence of disease relapse. In this paper, we discuss how some of the challenges in the management of GPA have been and continue to be addressed including: reducing the toxicity of induction therapy; developing biomarkers to determine who can safely stop maintenance immunosuppression; improving the efficacy of maintenance therapy for relapsing patients; managing localized disease; and management of disease and treatment-associated comorbidity. Consideration is also given to emerging therapeutics in the treatment of GPA. PMID:24790453

Innovative Approaches in Chronic Disease Management: Health Literacy Solutions and Opportunities for Research Validation.

PubMed

Villaire, Michael; Gonzalez, Diana Peña; Johnson, Kirby L

2017-01-01

This chapter discusses the need for innovative health literacy solutions to combat extensive chronic disease prevalence and costs. The authors explore the intersection of chronic disease management and health literacy. They provide specific examples of successful health literacy interventions for managing several highly prevalent chronic diseases. This is followed by suggestions on pairing research and practice to support effective disease management programs. In addition, the authors discuss strategies for collection and dissemination of knowledge gained from collaborations between researchers and practitioners. They identify current challenges specific to disseminating information from the health literacy field and offer potential solutions. The chapter concludes with a brief look at future directions and organizational opportunities to integrate health literacy practices to address the need for effective chronic disease management.

Obesity management in Prader-Willi syndrome.

PubMed

Salehi, Parisa; Leavitt, Anne; Beck, Anita E; Chen, Maida L; Roth, Christian L

2015-03-01

Prader-Willi Syndrome (PWS) is one of the most common genetic causes of obesity. The phenotype of obesity in PWS is unique and characterized by hyperphagia, earlier meal initiation, delayed meal termination, reduced energy expenditure, abnormal gut hormone profiles, as well as irregular responses to food in areas of the brain associated with satiety and reward. Management of obesity is necessary to avoid major morbidity. The relentless food-seeking behavior associated with PWS such as stealing, hoarding food, eating inedibles, and lying about eating, can cause turmoil both inside and outside of the home. Management is challenging for both patients and caretakers, but at this time there are limited medical therapies available besides dietary restriction and behavior management. However, current research shows promise for discovery of additional treatment options for hyperphagia and obesity management in PWS.

Anthropogenic Trace Compounds (ATCs) in aquatic habitats - research needs on sources, fate, detection and toxicity to ensure timely elimination strategies and risk management.

PubMed

Gerbersdorf, Sabine U; Cimatoribus, Carla; Class, Holger; Engesser, Karl-H; Helbich, Steffen; Hollert, Henner; Lange, Claudia; Kranert, Martin; Metzger, Jörg; Nowak, Wolfgang; Seiler, Thomas-Benjamin; Steger, Kristin; Steinmetz, Heidrun; Wieprecht, Silke

2015-06-01

Anthropogenic Trace Compounds (ATCs) that continuously grow in numbers and concentrations are an emerging issue for water quality in both natural and technical environments. The complex web of exposure pathways as well as the variety in the chemical structure and potency of ATCs represents immense challenges for future research and policy initiatives. This review summarizes current trends and identifies knowledge gaps in innovative, effective monitoring and management strategies while addressing the research questions concerning ATC occurrence, fate, detection and toxicity. We highlight the progressing sensitivity of chemical analytics and the challenges in harmonization of sampling protocols and methods, as well as the need for ATC indicator substances to enable cross-national valid monitoring routine. Secondly, the status quo in ecotoxicology is described to advocate for a better implementation of long-term tests, to address toxicity on community and environmental as well as on human-health levels, and to adapt various test levels and endpoints. Moreover, we discuss potential sources of ATCs and the current removal efficiency of wastewater treatment plants (WWTPs) to indicate the most effective places and elimination strategies. Knowledge gaps in transport and/or detainment of ATCs through their passage in surface waters and groundwaters are further emphasized in relation to their physico-chemical properties, abiotic conditions and biological interactions in order to highlight fundamental research needs. Finally, we demonstrate the importance and remaining challenges of an appropriate ATC risk assessment since this will greatly assist in identifying the most urgent calls for action, in selecting the most promising measures, and in evaluating the success of implemented management strategies. Copyright © 2015. Published by Elsevier Ltd.

Managing Records for the Long Term - 12363

DOE Office of Scientific and Technical Information (OSTI.GOV)

Montgomery, John V.; Gueretta, Jeanie

The U.S. Department of Energy (DOE) is responsible for managing vast amounts of information documenting historical and current operations. This information is critical to the operations of the DOE Office of Legacy Management. Managing legacy records and information is challenging in terms of accessibility and changing technology. The Office of Legacy Management is meeting these challenges by making records and information management an organizational priority. The Office of Legacy Management mission is to manage DOE post-closure responsibilities at former Cold War weapons sites to ensure the future protection of human health and the environment. These responsibilities include environmental stewardship andmore » long-term preservation and management of operational and environmental cleanup records associated with each site. A primary organizational goal for the Office of Legacy Management is to 'Preserve, Protect, and Share Records and Information'. Managing records for long-term preservation is an important responsibility. Adequate and dedicated resources and management support are required to perform this responsibility successfully. Records tell the story of an organization and may be required to defend an organization in court, provide historical information, identify lessons learned, or provide valuable information for researchers. Loss of records or the inability to retrieve records because of poor records management processes can have serious consequences and even lead to an organisation's downfall. Organizations must invest time and resources to establish a good records management program because of its significance to the organization as a whole. The Office of Legacy Management will continue to research and apply innovative ways of doing business to ensure that the organization stays at the forefront of effective records and information management. DOE is committed to preserving records that document our nation's Cold War legacy, and the Office of Legacy Management will keep records management as a high priority. (authors)« less

Anticlotting agents and the surgical management of glaucoma.

PubMed

Sozeri, Yasemin; Salim, Sarwat

2018-03-01

A large subset of patients with glaucoma uses anticlotting agents. No standardized guidelines currently exist for managing these agents in the specific perioperative setting of glaucoma surgery. The present review focuses on currently available anticlotting agents, their influence on hemorrhagic complications following glaucoma surgery, and management strategies for their use in the perioperative period RECENT FINDINGS: Anticlotting agents increase the risk of perioperative hemorrhagic complications following glaucoma surgery. Other factors that increase that risk have been identified as well, including the type of glaucoma surgery, preoperative intraocular pressure, postoperative hypotony, previous ocular surgeries, and race. Although general guidelines in the perioperative management of blood thinning agents exist, the best way to apply these guidelines specifically to glaucoma surgery remains unclear. Blood thinners are widely used and can increase the risk of hemorrhagic complications in patients undergoing glaucoma surgery. Managing these agents in the perioperative setting is challenging and should be done in collaboration with the patient's primary care provider, hematologist, or cardiologist. Management strategies should be tailored to each individual's risk of hemorrhage versus thromboembolism. Additionally, surgical plans can be modified to help minimize hemorrhagic outcomes, especially in patients who are deemed to be at high risk for perioperative bleeding.

Adaptation Challenges in Complex River Basins: Lessons Learned and Unlearned for the Colorado

NASA Astrophysics Data System (ADS)

Pulwarty, R. S.

2008-12-01

Climate variations affect the function and operation of existing water infrastructure - including hydropower, structural flood defenses, drainage and irrigation systems - as well as water management practices in support of efficiency and environmental needs. Selected basins around the world, including the Colorado, show agreements in model projections of increasing aridity. Adverse effects of climate change on freshwater systems aggravate the impacts of other stresses, such as population growth, changing economic activity, land-use change and urbanization and most importantly upstream-downstream winners and losers. Thus current water management practices may not be robust enough to cope with the impacts of climate change on water supply reliability. In many locations, water management does not even satisfactorily cope with current climate variability, so that large flood and drought-related environmental and economic damages occur on seasonal to decadal timescales. The recently released IPCC Technical Paper notes that adaptation procedures and risk management practices that incorporate projected hydrological changes with related uncertainties are being developed in some countries and regions.In this presentation we will review the challenges and lessons provided in drought and water resources management and optimization in the context of climate variability and projected change in the Western U.S., the European Union (including the Iberian Peninsula), the Murray-Darling Basin, and elsewhere. Since the release of the IPCC report several of the authors (including the presenter) have held meetings on comparative assessments of adaptation and its challenges in interstate and international river basins. As a first step, improved incorporation of information about current climate variability into water-related management could assist adaptation to longer-term climate change impacts. Future adaptations include technical changes that improve water use efficiency, demand management (e.g. through metering and pricing), and institutional changes that improve the tradability of water rights. The co-evolution of climate history and adaptation did not start with the release of IPCC scenarios. The development of the Colorado River Basin was itself influenced by water resources planners from around the world (including the Middle East) in the late 1800s. As such lessons identified, but not always learned, abound. These hold considerable promise for water savings and the reallocation of water to highly valued uses. Supply-side strategies generally involve increases in storage capacity, abstraction from watercourses, and water transfers. Integrated water resources management provides an important governance framework to achieve adaptation measures across socio-economic, environmental and administrative systems. However, several paradoxes in water management and governance mitigate against the effectiveness of scientific information for meeting short term needs in the context of reducing longer-term vulnerabilities and for providing water to meet environmental needs. Consequently a complete analysis of the effects of climate change on human water uses would consider cross-sector interactions, including the impacts of changes in water use efficiency and intentional transfers of the use of water from one sector to another.

The Acquisition Process as a Vehicle for Enabling Knowledge Management in the Lifecycle of Complex Federal Systems

NASA Technical Reports Server (NTRS)

Stewart, Helen; Spence, Matt Chew; Holm, Jeanne; Koga, Dennis (Technical Monitor)

2001-01-01

This white paper explores how to increase the success and operation of critical, complex, national systems by effectively capturing knowledge management requirements within the federal acquisition process. Although we focus on aerospace flight systems, the principles outlined within may have a general applicability to other critical federal systems as well. Fundamental design deficiencies in federal, mission-critical systems have contributed to recent, highly visible system failures, such as the V-22 Osprey and the Delta rocket family. These failures indicate that the current mechanisms for knowledge management and risk management are inadequate to meet the challenges imposed by the rising complexity of critical systems. Failures of aerospace system operations and vehicles may have been prevented or lessened through utilization of better knowledge management and information management techniques.

Fundamental Technology Development for Gas-Turbine Engine Health Management

NASA Technical Reports Server (NTRS)

Mercer, Carolyn R.; Simon, Donald L.; Hunter, Gary W.; Arnold, Steven M.; Reveley, Mary S.; Anderson, Lynn M.

2007-01-01

Integrated vehicle health management technologies promise to dramatically improve the safety of commercial aircraft by reducing system and component failures as causal and contributing factors in aircraft accidents. To realize this promise, fundamental technology development is needed to produce reliable health management components. These components include diagnostic and prognostic algorithms, physics-based and data-driven lifing and failure models, sensors, and a sensor infrastructure including wireless communications, power scavenging, and electronics. In addition, system assessment methods are needed to effectively prioritize development efforts. Development work is needed throughout the vehicle, but particular challenges are presented by the hot, rotating environment of the propulsion system. This presentation describes current work in the field of health management technologies for propulsion systems for commercial aviation.

Examining the Challenging Hindrances facing in the Construction Projects: South India’s Perspective

NASA Astrophysics Data System (ADS)

Subramanyam, K.; Haridharan, M. K.

2017-07-01

Developing countries like India require a huge infrastructure to facilitate needs of the people. Construction industry provides several opportunities to the individuals. Construction manager work is to supervise and organize the construction activities in construction projects. Now a day construction manager facing challenges. This paper aimed to study the challenges facing by the construction manager in the perception of construction professionals. 39 variables were taken from the literature review which found to be severe impact on construction managers’ performance. Construction manager, project manager and site engineers are the respondents for this survey. Using SPSS, regression analysis was done and recognized significant challenges. These challenges were classified into 5 domains. In management challenges, resource availability and allocation, risks and uncertainties existing in the project onsite, top management support and cost constraints are the most significant variables. In skills requirement of a construction manager challenges, technical skills required to learn and adapt new technology in the project, decision making and planning according to the situation in site are the most significant variables. In performance challenges, implementation of tasks according to the plan is the important variable whereas in onsite challenges, manage project risks, develop project policies and procedures are the most important.

CHALLENGES IN THE MANAGEMENT OF GLAUCOMA IN A DEVELOPING COUNTRY; A QUALITATIVE STUDY OF PROVIDERS' PERSPECTIVES.

PubMed

Adekoya, B J; Adepoju, F G; Moshood, K F; Balarabe, A H

2015-01-01

Glaucoma management is challenging to patients as well as to the eye care providers. The study is aimed at describing the challenges faced by providers using qualitative methods. In-depth interviews were conducted with selected Ophthalmologists and resident doctors in ophthalmology at centres offering medical and surgical glaucoma services in Lagos state, Nigeria, according to established qualitative methods. This was done using semi-structured, open ended questions to explore the providers' perspective on glaucoma burden, challenges in the management, surgery for glaucoma, acceptance of glaucoma surgery by patients, and recommendations for improving glaucoma services. The discussions were recorded with the aid of a micro-cassette recorder. Familiarisation was done to identify key ideas in the data, then, the main themes and sub-themes were identified. Quotes that reflect the themes and sub-themes were then identified in the data. In-depth interviews were conducted with a total of 11 ophthalmologists and resident doctors in training. Majority were of the opinion that glaucoma is a significant burden constituting about 35% of outpatient visits. Identified patient related challenges include; late presentation, lack of glaucoma awareness, delay in referral from optometrists, and poor compliance with medications. Shortages in needed equipment were also identified. Availability, affordability and counterfeiting of drugs were the major challenges related to medical treatment. Majority of the participants agreed that surgery should be offered to the patients as soon as the diagnosis of glaucoma is made. However, continuous monitoring of the patient on medical treatment is another line of option for them in early cases; if they are convinced the patients will be compliant. Some respondents considered the current number of glaucoma surgeries as adequate, while some think otherwise. Reasons put forward for reluctance to offer glaucoma surgery include; late presentation, lack of patient satisfaction, complications of surgery, and negative publicity. Even though the challenges in the management of glaucoma in developing countries are many, they are not insurmountable. There is need for concerted and integrated efforts involving all cadres of eye care practitioners, patients, institutions and governments to address this important eye disease. Improved awareness, provision of adequate equipment, availability and affordability of medications, need for training and retraining of eye care providers are all important measures that can lead to better management of the glaucoma patient.

[Clinical and health economic challenges of personalized medicine].

PubMed

Brüggenjürgen, B; Kornbluth, L; Ferrara, J V; Willich, S N

2012-05-01

Healthcare systems across the globe are currently challenged by aging populations, increases in chronic diseases and the difficult task of managing a healthcare budget. In this health economic climate, personalized medicine promises not only an improvement in healthcare delivery but also the possibility of more cost-effective therapies. It is important to remember, however, that personalized medicine has the potential to both increase and decrease costs. Each targeted therapy must be evaluated individually. However, standard clinical trial design is not suitable for personalized therapies. Therefore, both scientists and regulatory authorities will need to accept innovative study designs in order to validate personalized therapies. Hence correct economic evaluations are difficult to carry out due to lack of clear clinical evidence, longitudinal accounting and experience with patient/clinician behavior in the context of personalized medicine. In terms of reimbursement, payers, pharmaceutical companies and companion diagnostic manufacturers will also need to explore creative risk-sharing concepts. Germany is no exception to the challenges that face personalized medicine and for personalized medicine to really become the future of medicine many health economic challenges first need to be overcome. The health economic implications of personalized medicine remain unclear but it is certain that the expansion of targeted therapies in current healthcare systems will create a host of challenges.

Changing therapeutic paradigms in CMV retinitis in AIDS.

PubMed

Piper, H; Ciulla, T A; Danis, R P; Pratt, L M

2000-12-01

Cytomegalovirus (CMV) retinitis is a common ocular complication of immunosuppression. The management of CMV retinitis has been continuously evolving over the last decade. The mainstay of therapy remains ganciclovir and foscarnet. However, increasing resistance and ongoing toxicities to these agents remain a challenge. Additional frequently utilised agents include cidofovir and fomivirsen. The advent of highly active antiretroviral therapy (HAART) has allowed the restoration of immunocompetency to many patients previously challenged by CMV infection. In some circumstances, HAART has even eliminated the need for ongoing antiviral therapy. This paper reviews the current treatment modalities, including their toxicities and dosing recommendations.

Burning Mouth Syndrome.

PubMed

Klasser, Gary D; Grushka, Miriam; Su, Nan

2016-08-01

Burning mouth syndrome (BMS) is an enigmatic, misunderstood, and under-recognized painful condition. Symptoms associated with BMS can be varied, thereby providing a challenge for practitioners and having a negative impact on oral health-related quality of life for patients. Management also remains a challenge for practitioners because it is currently only targeted for symptom relief without a definitive cure. There is an urgent need for further investigations to determine the efficacy of different therapies because this is the only way viable therapeutic options can be established for patients with this chronic and painful syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

Challenges and Strategies for Breeding Resistance in Capsicum annuum to the Multifarious Pathogen, Phytophthora capsici

PubMed Central

Barchenger, Derek W.; Lamour, Kurt H.; Bosland, Paul W.

2018-01-01

Phytophthora capsici is the most devastating pathogen for chile pepper production worldwide and current management strategies are not effective. The population structure of the pathogen is highly variable and few sources of widely applicable host resistance have been identified. Recent genomic advancements in the host and the pathogen provide important insights into the difficulties reported by epidemiological and physiological studies published over the past century. This review highlights important challenges unique to this complex pathosystem and suggests strategies for resistance breeding to help limit losses associated with P. capsici. PMID:29868083

Asthma Management in the Era of Smart-Medicine: Devices, Gadgets, Apps and Telemedicine.

PubMed

Katwa, Umakanth; Rivera, Estefania

2018-03-10

Asthma is the most common chronic pediatric condition. Effective asthma management requires a proactive and inclusive approach that controls the patient's symptoms and prevents recurrence of exacerbations. Clinicians should encourage patients to become involved in their management since self-management approaches have proven to be an effective means for chronic illness treatment. Novel forms of self-monitoring and management are technological interventions. In the last decade, novel technology has been developed and used to improve asthma control since it is a powerful agent that addresses a variety of challenges in chronic disease management such as education, communication and adherence. A myriad of technology-based strategies are available although many of these are not evidence based and further studies are needed to evaluate their efficacy in specific asthma-control endpoints. Herein, authors present a review of current and future technology-based options for asthma management and a comparison between them.

In situ fenestrations for the aortic arch and visceral segment: advances and challenges.

PubMed

Riga, Celia V; McWilliams, Richard G; Cheshire, Nicholas J W

2011-09-01

The management of complex aortic pathologies remains a major challenge particularly in the emergency setting. Bespoke fenestrated and branch stent graft technology has shown encouraging short- and mid-term results in selected patients. Despite tremendous technological advances in this field however, factors such as the inherent delay in device manufacturing, anatomical and technical challenges, high degree of planning, and cost hinder the wider applications of minimally invasive endovascular therapy. In situ fenestration of aortic stent grafts is an attractive alternative that eliminates the need for preoperative custom tailoring with the potential to widen the therapeutic options available and to offer a bailout option after inadvertent side branch occlusion. This article summarizes the principles of this technique and discusses its current applications.

Managing today's complex healthcare business enterprise: reflections on distinctive requirements of healthcare management education.

PubMed

Welton, William E

2004-01-01

In early 2001, the community of educational programs offering master's-level education in healthcare management began an odyssey to modernize its approach to the organization and delivery of healthcare management education. The community recognized that cumulative long-term changes within healthcare management practice required a careful examination of healthcare management context and manpower requirements. This article suggests an evidence-based rationale for defining the distinctive elements of healthcare management, thus suggesting a basis for review and transformation of master's-level healthcare management curricula. It also suggests ways to modernize these curricula in a manner that recognizes the distinctiveness of the healthcare business enterprise as well as the changing management roles and careers within these complex organizations and systems. Through such efforts, the healthcare management master's-level education community would be better prepared to meet current and future challenges, to increase its relevance to the management practice community, and to allocate scarce faculty and program resources more effectively.

Crew Exploration Vehicle Environmental Control and Life Support Fire Protection Approach

NASA Technical Reports Server (NTRS)

Lewis, John F.; Barido, Richard; Tuan, George C.

2007-01-01

As part of preparing for the Crew Exploration Vehicle (CEV), the National Aeronautics and Space Administration (NASA) worked on developing the requirements to manage the fire risk. The new CEV poses unique challenges to current fire protection systems. The size and configuration of the vehicle resembles the Apollo capsule instead of the current Space Shuttle or the International Space Station. The smaller free air volume and fully cold plated avionic bays of the CEV requires a different approach in fire protection than the ones currently utilized. The fire protection approach discussed in this paper incorporates historical lessons learned and fire detection and suppression system design philosophy spanning from Apollo to the International Space Station. Working with NASA fire and materials experts, this approach outlines the best requirements for both the closed out area of the vehicle, such as the avionics bay, and the crew cabin area to address the unique challenges due to the size and configuration of the CEV.

Diagnosing cystic fibrosis-related diabetes: current methods and challenges.

PubMed

Prentice, Bernadette; Hameed, Shihab; Verge, Charles F; Ooi, Chee Y; Jaffe, Adam; Widger, John

2016-07-01

Cystic fibrosis-related diabetes (CFRD) is the end-point of a spectrum of glucose abnormalities in cystic fibrosis that begins with early insulin deficiency and ultimately results in accelerated nutritional decline and loss of lung function. Current diagnostic and management regimens are unable to entirely reverse this clinical decline. This review summarises the current understanding of the pathophysiology of CFRD, the issues associated with using oral glucose tolerance tests in CF and the challenges faced in making the diagnosis of CFRD. Medline database searches were conducted using search terms "Cystic Fibrosis Related Diabetes", "Cystic Fibrosis" AND "glucose", "Cystic Fibrosis" AND "insulin", "Cystic Fibrosis" AND "Diabetes". Additionally, reference lists were studied. Expert commentary: Increasing evidence points to early glucose abnormalities being clinically relevant in cystic fibrosis and as such novel diagnostic methods such as continuous glucose monitoring or 30 minute sampled oral glucose tolerance test (OGTT) may play a key role in the future in the screening and diagnosis of early glucose abnormalities in CF.

Health impact assessment in Mongolia: current situation, directions, and challenges.

PubMed

Spickett, Jeff; Batmunkh, Tsetsegsaikhan; Jones, Sarah

2015-03-01

Many developing countries have limited capacity to adequately assess and manage health impacts associated with environmental change. In Mongolia, methodologies to introduce health impact assessment (HIA) as part of the environmental impact assessment (EIA) process have been investigated, and a mechanism to incorporate HIA into the current EIA process is proposed. Some challenges to the implementation of HIA are discussed. The country is now in a position to incorporate HIA as part of the approvals process for development projects. Given the recent growth in population, industrial development, and urbanization together with the interest from international mining companies in the resources of the country, it is important for Mongolia to have such tools in place in order to take advantage of economic growth while improving health and well-being outcomes for the population. © 2012 APJPH.

Current status of solid waste management in small island developing states: A review

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mohee, Romeela; Mauthoor, Sumayya, E-mail: sumayya.mauthoor@umail.uom.ac.mu; Bundhoo, Zumar M.A.

Highlights: • Waste management is a matter of great concern for small island developing states. • On average, waste generation rate in these islands amounts to 1.29 kg/capita/day. • Illegal dumping and landfilling prevail in most small island developing states. • Sustainable waste management practices, previously absent, are now emerging. • However, many challenges still hinder the implementation of these practices. - Abstract: This article reviews the current status of waste management in Small Island Developing States (SIDS) and the challenges that are faced in solid waste management. The waste generation rates of SIDS were compared within the three geographicmore » regions namely Caribbean SIDS, Pacific SIDS and Atlantic, Indian Ocean, Mediterranean and South China (AIMS) SIDS and with countries of the Organisation for Economic Co-Operation and Development (OECD). Only Pacific SIDS had a waste generation rate less than 1 kg/capita/day. The waste generation rates for the three SIDS regions averaged 1.29 kg/capita/day while that for OECD countries was at a mean value of 1.35 kg/capita/day. The waste compositions in the different SIDS regions were almost similar owing to comparable consumption patterns while these differed to a large extent with wastes generated in OECD countries. In SIDS, the major fraction of MSW comprised of organics (44%) followed by recyclables namely paper, plastics, glass and metals (total: 43%). In contrast, MSW in OECD countries consisted mainly of recyclables (43%) followed by organics (37%). This article also reviewed the other functional elements of the waste management systems in SIDS. Several shortcomings were noted in the process of waste collection, transfer and transport namely the fact of having outdated collection vehicles and narrow roads which are inaccessible. Among the waste management practices in SIDS, waste disposal via landfilling, illegal dumping and backyard burning were favoured most of the time at the expense of sustainable waste treatment technologies such as composting, anaerobic digestion and recycling.« less

Data Curation Education in Research Centers (DCERC)

NASA Astrophysics Data System (ADS)

Marlino, M. R.; Mayernik, M. S.; Kelly, K.; Allard, S.; Tenopir, C.; Palmer, C.; Varvel, V. E., Jr.

2012-12-01

Digital data both enable and constrain scientific research. Scientists are enabled by digital data to develop new research methods, utilize new data sources, and investigate new topics, but they also face new data collection, management, and preservation burdens. The current data workforce consists primarily of scientists who receive little formal training in data management and data managers who are typically educated through on-the-job training. The Data Curation Education in Research Centers (DCERC) program is investigating a new model for educating data professionals to contribute to scientific research. DCERC is a collaboration between the University of Illinois at Urbana-Champaign Graduate School of Library and Information Science, the University of Tennessee School of Information Sciences, and the National Center for Atmospheric Research. The program is organized around a foundations course in data curation and provides field experiences in research and data centers for both master's and doctoral students. This presentation will outline the aims and the structure of the DCERC program and discuss results and lessons learned from the first set of summer internships in 2012. Four masters students participated and worked with both data mentors and science mentors, gaining first hand experiences in the issues, methods, and challenges of scientific data curation. They engaged in a diverse set of topics, including climate model metadata, observational data management workflows, and data cleaning, documentation, and ingest processes within a data archive. The students learned current data management practices and challenges while developing expertise and conducting research. They also made important contributions to NCAR data and science teams by evaluating data management workflows and processes, preparing data sets to be archived, and developing recommendations for particular data management activities. The master's student interns will return in summer of 2013, and two Ph.D. students will conduct data curation-related dissertation fieldwork during the 2013-2014 academic year.

Single-stage-to-orbit: Meeting the challenge

NASA Astrophysics Data System (ADS)

Freeman, Delma C., Jr.; Talay, Theodore A.; Austin, Robert Eugene

1995-10-01

There has been and continues to be significant discussion about the viability of fully reusable, single-stage-to-orbit (SSTO) concepts for delivery of payloads to orbit. Often, these discussions have focused in detail on performance and technology requirements relating to the technical feasibility of the concept, with only broad generalizations on how the SSTO will achieve its economic goals of greatly reduced vehicle ground and flight operations costs. With the current industry and NASA Reusable Launch Vehicle Technology Program efforts underway to mature and demonstrate technologies leading to a viable commercial launch system that also satisfies national needs, achieving acceptable recurring costs becomes a significant challenge. This paper reviews the current status of the Reusable Launch Vehicle Technology Program including the DC-XA, X-33, and X-34 flight systems and associated technology programs. The paper also examines lessons learned from the recently completed DC-X reusable rocket demonstrator program. It examines how these technologies and flight systems address the technical and operability challenges of SSTO whose solutions are necessary to reduce costs. The paper also discusses the management and operational approaches that address the challenge of a new cost-effective, reusable launch vehicle system.

Single-stage-to-orbit — Meeting the challenge

NASA Astrophysics Data System (ADS)

Freeman, Delma C.; Talay, Theodore A.; Austin, Robert Eugene

1996-02-01

There has been and continues to be significant discussion about the viability of fully reusable, single-stage-to-orbit (SSTO) concepts for delivery of payloads to orbit. Often, these discussions have focused in detail on performance and technology requirements relating to the technical feasibility of the concept, with only broad generalizations on how the SSTO will achieve its economic goals of greatly reduced vehicle ground and flight operations costs. With the current industry and NASA Reusable Launch Vehicle Technology Program efforts underway to mature and demonstrate technologies leading to a viable commercial launch system that also satisfies national needs, achieving acceptable recurring costs becomes a significant challenge. This paper reviews the current status of the Reusable Launch Vehicle Technology Program including the DC-XA, X-33, X-34 flight systems and associated technology programs. The paper also examines lessons learned from the recently completed DC-X reusable rocket demonstrator program. It examines how these technologies and flight systems address the technical and operability challenges of SSTO whose solutions are necessary to reduce costs. The paper also discusses the management and operational approaches that address the challenge of a new cost-effective, reusable launch vehicle system.

The Effects of a Strengths-Based Assessment and Development Program on First-Term Masters of Business Administration Students and Future Academic Success

ERIC Educational Resources Information Center

Hohn, Michael C.

2009-01-01

Adults returning to graduate school to acquire a master of business administration (MBA) degree face a myriad of challenges as they attempt to manage academic responsibilities, work, family, and social obligations. Currently, a number of educational professionals only look to identify and remediate student deficiencies. Developing existing…

A perspective on laboratory utilization management from Canada.

PubMed

Naugler, Christopher

2014-01-01

Utilization, particularly in chemistry and molecular testing, is growing rapidly in Canada at a time when laboratory budgets are shrinking. Canadian laboratories face particular challenges as the prevailing funding model limits the scope for new revenue generation. Aggressive and coordinated interventions to reduce over-utilization will be necessary to ensure the long-term viability of the current system. © 2013.

The Challenge of the Age and Competency Structure in Industry for Innovations and Human Resource Policy.

ERIC Educational Resources Information Center

Kroll, Martin

2003-01-01

Analyzes the weaknesses of current structural options in Germany that allow older workers to keep on working. Points out that data do not indicate older workers are reluctant to participate in training. Suggests that management of competency development is unsuitable for the further employment of older adults. (Contains 56 references and 36…

Sense of place in natural resource recreation and tourism: an evaluation and assessment of research findings.

Treesearch

Jennifer Farnum; Troy Hall; Linda E. Kruger

2005-01-01

Understanding sense of place and related concepts often presents challenges for both managers and researchers. Inconsistent application of terms, questions regarding their origin, and a lack of awareness of research findings contribute to the ambiguity of these concepts. This integrative review of research provides relevant, current information on the role of sense of...

The Missouri River Floodplain: History of Oak Forest & Current Restoration Efforts

Treesearch

Daniel C. Dey; Dirk Burhans; John Kabrick; Brain Root; Jennifer Grabner; Mike Gold

2000-01-01

Efforts to restore floodplains are complicated by our variable understanding of history and ecology; our lack of knowledge of past environmental and vegetative conditions; and our differing viewpoints of what natural, what the role of humans is in the ecosystem, and what the desirable restored state is. Managers are challenged to decide how to restore native vegetation...

Identifying the Criteria for Planning the Selection and Succession of a CIO: A Phenomenological Study

ERIC Educational Resources Information Center

Williamson, Charles E.

2010-01-01

Many challenges face CIOs in their management of IT systems; yet, very little research is available regarding the issues and constraints associated with their role. CIO leadership is still a subject of inquiry for those with aspirations to pursue such a position. The specific problem of the current qualitative phenomenological study concerned the…

Managing Their Own Programme: A Case Study of the First Graduates of a New Kind of Doctorate in Professional Practice

ERIC Educational Resources Information Center

Stephenson, John; Malloch, Margaret; Cairns, Len

2006-01-01

This article contributes to current debates about professional doctorates from a lifelong learning perspective, focusing on those who choose to undertake a doctoral programme in mid- or late career and their responses to the challenge of demonstrating their "doctorateness" as evidenced in their previous and continuing professional work.…

Teaching a Cognitive Behavioral Strategy to Manage Emotions Rational Emotive Behavior Therapy in an Educational Setting

ERIC Educational Resources Information Center

Banks, Tachelle; Zionts, Paul

2009-01-01

The academic and social challenges facing public schools are enormous. For example, the pressure to meet the demands of the current high-stakes testing environment and reach adequate yearly progress (AYP) goals has arguably never been greater (Luna & Turner, 2001; Sanders, 2003). The energy devoted to academics has supplanted the little time spent…

Linking Classroom and Community: A Theoretical Alignment of Service Learning and a Human-Centered Design Methodology in Contemporary Communication Design Education

ERIC Educational Resources Information Center

Bowie, Anneli; Cassim, Fatima

2016-01-01

The current emphasis on social responsibility and community collaboration within higher education has led to an increased drive to include service learning in the curriculum. With its emphasis on mutually beneficial collaborations, service learning can be meaningful for both students and the community, but is challenging to manage successfully.…